Provider Demographics
NPI:1447222070
Name:AGARWALA, MEENA (MD)
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:
Last Name:AGARWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:
Practice Address - Street 1:44 W 21ST ST
Practice Address - Street 2:#101
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1221
Practice Address - Country:US
Practice Address - Phone:610-261-0999
Practice Address - Fax:610-261-2187
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052173L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011482998Medicaid
PAF82534Medicare UPIN
PA011482998Medicaid