Basic Information
Provider Information | |||||||||
NPI: | 1982918199 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AGARWAL | ||||||||
FirstName: | VIVEK | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 636930 | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452636930 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5139815123 | ||||||||
FaxNumber: | 5139815015 | ||||||||
Practice Location | |||||||||
Address1: | 750 W HIGH ST | ||||||||
Address2: | SUITE 150 | ||||||||
City: | LIMA | ||||||||
State: | OH | ||||||||
PostalCode: | 458012969 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4192271359 | ||||||||
FaxNumber: | 4192277586 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/29/2010 | ||||||||
LastUpdateDate: | 03/09/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08798300 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RN0300X | 065077 | GA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 35.121948 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | 65077 | GA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
No ID Information.