Healthcare Provider Details

I. General information

NPI: 1073542718
Provider Name (Legal Business Name): SUMON AGARWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARKET ST STE 300
COLLEGEVILLE PA
19426-4927
US

IV. Provider business mailing address

PO BOX 789967
PHILADELPHIA PA
19178-9967
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-6401
  • Fax: 484-622-6403
Mailing address:
  • Phone: 484-622-7395
  • Fax: 484-622-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD424645
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMA07458300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: