Healthcare Provider Details

I. General information

NPI: 1336189133
Provider Name (Legal Business Name): BAL K AGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W WILLIAMS ST STE 102
APEX NC
27502-3979
US

IV. Provider business mailing address

1011 W WILLIAMS ST STE 102
APEX NC
27502-3979
US

V. Phone/Fax

Practice location:
  • Phone: 919-794-4899
  • Fax: 828-633-0510
Mailing address:
  • Phone: 919-794-4899
  • Fax: 828-633-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01764
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: