Basic Information
| Provider Information | |||||||||
| NPI: | 1225224405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGGARWAL | ||||||||
| FirstName: | SUMITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 E ALTAMONTE DR | ||||||||
| Address2: | STE 2200 | ||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077670009 | ||||||||
| FaxNumber: | 4077670022 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 VALLEY VIEW DR. | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409477726 | ||||||||
| FaxNumber: | 7409477726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 09/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME126315 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1760659171 | 01 | OH | FACILITY NPI | OTHER | 3618391 | 01 | OH | FACILITY PTAN | OTHER |