Healthcare Provider Details

I. General information

NPI: 1487619474
Provider Name (Legal Business Name): SHELI AGARWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH CHURCH ST
MIDDLETOWN MD
21769
US

IV. Provider business mailing address

3713 SPICEBUSH DR
FREDERICK MD
21704-7879
US

V. Phone/Fax

Practice location:
  • Phone: 301-371-9000
  • Fax: 301-371-8905
Mailing address:
  • Phone: 301-874-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0061611
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: