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NPI Code Detail

MEDICARE: DR. VIJAYA K AGARWALA M.D.

MEDICARE: DR. VIJAYA K AGARWALA M.D.
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
1207L00000XAnesthesiology PhysicianMD057970LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1739079OTHERPAHIGHMARK BLUE SHIELD
200020289904OTHERNYUNIVERA

General Provider Information

NPI Number : 1346239993
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VIJAYA K AGARWALA M.D.
Provider Business Mailing Address
First Line : 2 W CRESCENT PARK
Second Line :
City : WARREN
State : PA
Zip : 16365-2111
Country : US
Telephone Number : 814-723-3300
Fax Number : 814-723-8515
Provider Business Practice Location Address
First Line : 2 W CRESCENT PARK
Second Line :
City : WARREN
State : PA
Zip : 16365-2111
Country : US
Telephone Number : 814-723-3300
Fax Number : 814-723-8515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 10/18/2007

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