Basic Information
| Provider Information | |||||||||
| NPI: | 1023374204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGARWALLA | ||||||||
| FirstName: | NIRAJ | ||||||||
| MiddleName: | KUMAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 S 11TH ST | ||||||||
| Address2: | SUITE 8280 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159552370 | ||||||||
| FaxNumber: | 2159550677 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 11TH STREET | ||||||||
| Address2: | SUITE 8490 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556161 | ||||||||
| FaxNumber: | 2159235507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OS018089 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | OS018089 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
No ID Information.