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1174749014

NPI Code Detail

MEDICARE: JENNIFER AGOSTA MD

MEDICARE: JENNIFER AGOSTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD2008-0157	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	570315YY54	OTHER	NM	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174749014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AGOSTA MD

Provider Business Mailing Address
First Line	:	4351 E LOHMAN AVE STE 320
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8262
Country	:	US
Telephone Number	:	575-556-3240
Fax Number	:	575-522-3092

Provider Business Practice Location Address
First Line	:	4351 E LOHMAN AVE STE 320
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8262
Country	:	US
Telephone Number	:	575-556-3240
Fax Number	:	575-522-3092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	12/21/2017

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Directions to “ JENNIFER AGOSTA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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