Healthcare Provider Details

I. General information

NPI: 1942690193
Provider Name (Legal Business Name): MALHAR AGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD STE 3075
JACKSONVILLE FL
32216-1475
US

IV. Provider business mailing address

655 WEST 8TH STREET, ACC BLDG 5TH FLOOR C-35
JACKSONVILLE FL
32209
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-5785
  • Fax: 904-296-4786
Mailing address:
  • Phone: 904-383-1011
  • Fax: 904-244-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: