Provider Demographics
NPI:1548308679
Name:AGNEW, CLAUDIA ELISABETTA (PA)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ELISABETTA
Last Name:AGNEW
Suffix:
Gender:F
Credentials:PA
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 18428
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8428
Mailing Address - Country:US
Mailing Address - Phone:256-705-4224
Mailing Address - Fax:
Practice Address - Street 1:3601 CCI DR.
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805
Practice Address - Country:US
Practice Address - Phone:256-705-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528701110Medicaid
ALCA0084OtherRR MEDICARE
AL51545058OtherBCBS OF ALABAMA
AL510-50070OtherBCBS OF ALABAMA
AL051538755OtherMEDICARE NUMBER
AL51538755OtherBCBS OF ALABAMA
AL51545057OtherBCBS OF ALABAMA
AL51545057OtherBCBS OF ALABAMA
ALP01046Medicare UPIN