Healthcare Provider Details

I. General information

NPI: 1588077366
Provider Name (Legal Business Name): BHARAT DAS AGARWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 GREYSTONE RD
CHARLESTON WV
25314-2211
US

IV. Provider business mailing address

1623 GREYSTONE RD
CHARLESTON WV
25314-2211
US

V. Phone/Fax

Practice location:
  • Phone: 304-545-6102
  • Fax:
Mailing address:
  • Phone: 304-545-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11261
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: