Basic Information
Provider Information
NPI: 1376770008
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AGARWAL
FirstName: SAURABH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 125 METRO CENTER BLVD STE 2000
Address2:  
City: WARWICK
State: RI
PostalCode: 028861785
CountryCode: US
TelephoneNumber: 4014322500
FaxNumber: 4014538220
Practice Location
Address1: 125 METRO CENTER BLVD STE 2000
Address2:  
City: WARWICK
State: RI
PostalCode: 028861785
CountryCode: US
TelephoneNumber: 4014322500
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2009
LastUpdateDate: 03/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XMD14876RIY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X14876RIN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X257907MAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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