Healthcare Provider Details

I. General information

NPI: 1346426350
Provider Name (Legal Business Name): PREM ARORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MARTIN LUTHER KING JR WAY SUITE 103
TACOMA WA
98405-4250
US

IV. Provider business mailing address

314 MARTIN LUTHER KING JR WAY SUITE 103
TACOMA WA
98405-4250
US

V. Phone/Fax

Practice location:
  • Phone: 313-418-9624
  • Fax:
Mailing address:
  • Phone: 313-418-9624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301089678
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number60667080
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD60667080
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: