Provider Demographics
NPI:1558464248
Name:USHA AGARWAL MD PA
Entity type:Organization
Organization Name:USHA AGARWAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-846-9419
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-1945
Mailing Address - Country:US
Mailing Address - Phone:727-846-9419
Mailing Address - Fax:727-848-6200
Practice Address - Street 1:3543 LITTLE RD
Practice Address - Street 2:STE B
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1811
Practice Address - Country:US
Practice Address - Phone:727-846-9419
Practice Address - Fax:727-848-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG2097OtherRAILROAD MEDICARE
FLAD196Medicare PIN