Provider Demographics
NPI:1043290778
Name:AGGARWAL, ATUL A (MD)
Entity type:Individual
Prefix:
First Name:ATUL
Middle Name:A
Last Name:AGGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10898
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-0898
Mailing Address - Country:US
Mailing Address - Phone:661-664-0100
Mailing Address - Fax:661-664-0111
Practice Address - Street 1:9330 STOCKDALE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3614
Practice Address - Country:US
Practice Address - Phone:661-664-0100
Practice Address - Fax:661-664-0111
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53451207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00756145OtherMEDICARE RAILROAD
CA00C534510OtherBLUE SHIELD OF CA
CA00C534510Medicaid
CABH299AMedicare PIN
CA00C534510Medicare PIN
H83275Medicare UPIN