Healthcare Provider Details

I. General information

NPI: 1851307615
Provider Name (Legal Business Name): SAMIR AGARWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST STE 101
SARASOTA FL
34239-3508
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW SUITE 6B
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-3400
  • Fax:
Mailing address:
  • Phone: 202-741-3243
  • Fax: 202-741-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number21001
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35.095858
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME145876
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.095858
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21001
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number35.095858
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number21001
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: