Provider Demographics
NPI:1528321213
Name:AGARWAL, ASTHA (MD)
Entity type:Individual
Prefix:DR
First Name:ASTHA
Middle Name:
Last Name:AGARWAL
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 1:1602 ROCK PRAIRIE RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5988
Mailing Address - Country:US
Mailing Address - Phone:979-764-1111
Mailing Address - Fax:
Practice Address - Street 1:1602 ROCK PRAIRIE RD STE 2000
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5988
Practice Address - Country:US
Practice Address - Phone:979-764-1111
Practice Address - Fax:979-764-1164
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455873207R00000X
TXT3235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528321213Medicaid
PA686024OtherMEDICARE GROUP