Provider Demographics
NPI:1730172990
Name:AGARWAL, NIKHILESH (MD)
Entity type:Individual
Prefix:DR
First Name:NIKHILESH
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NIKHILESHWER
Other - Middle Name:
Other - Last Name:AGARWAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15 WYNTRE BROOKE DRIVE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4509
Mailing Address - Country:US
Mailing Address - Phone:717-741-9444
Mailing Address - Fax:717-741-4572
Practice Address - Street 1:15 WYNTRE BROOKE DRIVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4509
Practice Address - Country:US
Practice Address - Phone:717-741-9444
Practice Address - Fax:717-741-4572
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024908E208600000X, 2086S0102X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010099130002Medicaid
PAE51774Medicare UPIN
PA196111Medicare Oscar/Certification