Healthcare Provider Details

I. General information

NPI: 1558464248
Provider Name (Legal Business Name): USHA AGARWAL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 LITTLE RD STE B
TRINITY FL
34655-1811
US

IV. Provider business mailing address

PO BOX 1945
PALM HARBOR FL
34682-1945
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-9419
  • Fax: 727-848-6200
Mailing address:
  • Phone: 727-846-9419
  • Fax: 727-848-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: USHA AGARWAL
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 727-846-9419