=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720550015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAJIV AGARWAL MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2018
-----------------------------------------------------
Last Update Date | 07/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18980 W MEMORIAL DR STE 100
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77338-4472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-644-8930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18980 W MEMORIAL DR STE 100
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77338-4472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | RAJIV AGARWAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 832-644-8930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0404X
-----------------------------------------------------
Taxonomy Name | Cardiac Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------