Basic Information
Provider Information
NPI: 1477808939
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AGARWAL
FirstName: SALONI
MiddleName: SUNIL
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BALGI
OtherFirstName: SALONI
OtherMiddleName: SUNIL
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 1
Mailing Information
Address1: 1702 UNIVERSITY DR S
Address2:  
City: FARGO
State: ND
PostalCode: 581034940
CountryCode: US
TelephoneNumber: 7013644222
FaxNumber:  
Practice Location
Address1: 3000 32ND AVE S
Address2:  
City: FARGO
State: ND
PostalCode: 581036132
CountryCode: US
TelephoneNumber: 7013648000
FaxNumber: 7013648078
Other Information
ProviderEnumerationDate: 07/19/2012
LastUpdateDate: 01/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X125-060805ILN Allopathic & Osteopathic PhysiciansPediatrics 
2080N0001XQ3841TXN Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
2080N0001X15317NDY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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