Basic Information
| Provider Information | |||||||||
| NPI: | 1710306402 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | USHA AGARWAL MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337612236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278486400 | ||||||||
| FaxNumber: | 7278486200 | ||||||||
| Practice Location | |||||||||
| Address1: | 3543 LITTLE ROAD, STE A | ||||||||
| Address2: | DR. USHA AGARWAL MD PA | ||||||||
| City: | TRINITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346551945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785780914 | ||||||||
| FaxNumber: | 2069844412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | AGARWAL | ||||||||
| AuthorizedOfficialFirstName: | USHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6785780914 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | USHA AGARWAL MD | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 207RI0200X | FL | N | Hospitals | Long Term Care Hospital | 281P00000X | 207RI0200X | FL | Y | Hospitals | Chronic Disease Hospital |
ID Information
| ID | Type | State | Issuer | Description | 373995300 | 05 | FL | MEDICAID |