Healthcare Provider Details

I. General information

NPI: 1386296341
Provider Name (Legal Business Name): PRACHI AGARWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE
SCRANTON PA
18505-3814
US

IV. Provider business mailing address

21 BRIARWOOD WAY
SOUTH ABINGTON TOWNSHIP PA
18411-9094
US

V. Phone/Fax

Practice location:
  • Phone: 570-591-5264
  • Fax: 570-591-5209
Mailing address:
  • Phone: 408-507-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD477619
License Number StatePA

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: