Provider Demographics
NPI:1447458310
Name:AGARWAL, SANJAY J (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:J
Last Name:AGARWAL
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 1:150 W HEDDING ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-1706
Mailing Address - Country:US
Mailing Address - Phone:408-808-5200
Mailing Address - Fax:
Practice Address - Street 1:150 W HEDDING ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1706
Practice Address - Country:US
Practice Address - Phone:408-808-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 55624207R00000X
TN43943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38451871Medicare PIN
AL89031835OtherBCBS ALABAMA