Individual provider Active NPI

Abiara Vanessa Agwu, M.D.

  • Pediatrics Physician
  • Dallas, TX
National Provider Identifier
1023466604
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
FA7277189 Issued in TX
Practice address
1935 Medical District Dr
Dallas, TX 75235-7701
Phone
(844) 424-4537
NPI assigned
May 24, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X FA7277189 TX Primary

Addresses

Primary practice location

1935 Medical District Dr
Dallas, TX 75235-7701

Mailing address

1919 E Thomas Rd
Phoenix, AZ 85016-7710

Other practice location 1

1919 E Thomas Rd
Phoenix, AZ 85016-7710
Phone (602) 933-0198

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190925003564 TX Practitioner - Pediatric Medicine 8224368790 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
FA7277189TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jan 18, 2026 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jan 18, 2026 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Past Accepting new patients
Children'S Health System of Texas Past Accepting new patients

Locations

1935 Medical District Dr
Unit A
Dallas, TX 75235

1935 Medical District Dr
Dallas, TX 75235
Phone (214) 456-2735

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1023466604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 MEDICAL DISTRICT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357701",
            "telephone_number": "844-424-4537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 E Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850167710",
            "country_code": "US",
            "telephone_number": "602-933-0198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGWU",
        "first_name": "ABIARA",
        "middle_name": "VANESSA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-24",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "FA7277189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.