Healthcare Provider Details

I. General information

NPI: 1528610441
Provider Name (Legal Business Name): ANKIT AGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

130 RICK FRANCIS ST DEPT OF
EL PASO TX
79905-2841
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5710
  • Fax:
Mailing address:
  • Phone: 915-215-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberV8911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: