Provider Demographics
NPI:1366527855
Name:AGHA, NAUREEN IMTIAZ (MD)
Entity type:Individual
Prefix:
First Name:NAUREEN
Middle Name:IMTIAZ
Last Name:AGHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 WOOD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7580
Mailing Address - Country:US
Mailing Address - Phone:972-800-1380
Mailing Address - Fax:972-312-9178
Practice Address - Street 1:6130 W PARKER RD
Practice Address - Street 2:STE 512
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8031
Practice Address - Country:US
Practice Address - Phone:972-312-9169
Practice Address - Fax:972-312-9178
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.27677207R00000X
TXM9777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207681201Medicaid
TX207681202Medicaid
TX207681203Medicaid
TX207681203Medicaid
TX8L21326Medicare PIN
TX8L21319Medicare PIN