Individual provider · NPI-1

Dr. Omar Agosto, MD

Radiology, Diagnostic Radiology · Philadelphia, PA

NPI number1942403571
StatusActive
Last updated in NPPESJun 7, 2013

Details

NPI
1942403571
Entity type
Individual (NPI-1)
Name
Dr. Omar Agosto
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 10, 2007
Last updated
Jun 7, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2085R0202X Radiology, Diagnostic RadiologyMD427190PAYes
2085R0202X Radiology, Diagnostic Radiology2007013148MO

Practice location

3401 N Broad St
Philadelphia, PA 19140-5103

Phone 215-707-7237 · Fax 215-707-9386

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302

Phone 215-707-7237 · Fax 215-707-9386

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