Basic Information
| Provider Information | |||||||||
| NPI: | 1558464248 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | USHA AGARWAL MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1945 | ||||||||
| Address2: | |||||||||
| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346821945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278469419 | ||||||||
| FaxNumber: | 7278486200 | ||||||||
| Practice Location | |||||||||
| Address1: | 3543 LITTLE RD | ||||||||
| Address2: | STE B | ||||||||
| City: | TRINITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346551811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278469419 | ||||||||
| FaxNumber: | 7278486200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 09/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | AGARWAL | ||||||||
| AuthorizedOfficialFirstName: | USHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7278469419 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | DG2097 | 01 | RAILROAD MEDICARE | OTHER |