Healthcare Provider Details

I. General information

NPI: 1124257407
Provider Name (Legal Business Name): ABHISHEK AGARWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-8824
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1927
  • Fax: 916-781-1787
Mailing address:
  • Phone: 530-626-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD.204015
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number002494
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC149729
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC149729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: