MEDICARE: JENNIFER AGOSTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD2008-0157	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	570315YY54	OTHER	NM	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174749014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AGOSTA MD

Provider Business Mailing Address
First Line	:	4351 E LOHMAN AVE STE 320
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8262
Country	:	US
Telephone Number	:	575-556-3240
Fax Number	:	575-522-3092

Provider Business Practice Location Address
First Line	:	4351 E LOHMAN AVE STE 320
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8262
Country	:	US
Telephone Number	:	575-556-3240
Fax Number	:	575-522-3092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	12/21/2017

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Directions to “ JENNIFER AGOSTA MD” Practice Location

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