Healthcare Provider Details

I. General information

NPI: 1316923014
Provider Name (Legal Business Name): SANJEEV AGGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 LAKE MANASSAS DR
GAINESVILLE VA
20155-3257
US

IV. Provider business mailing address

PO BOX 357
SAN ANTONIO TX
78292-0357
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-4045
  • Fax: 703-753-8037
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101233545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: