Doctor Name: | GAUTAM AGRAWAL |
NPI Number: | 1063737070 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D , M.P.H |
License Number: | |
Business Practice Address: | 824 California Ave Avalon, PA - 152022706 |
Business Phone Number: | 4127663232 |
Business Fax Number: | 4127664320 |
Mailing Address: | 824 California Ave, AVALON |
State: | PA |
Postal Code: | 152022706 |
Phone Number: | 4127663232 |
Fax Number: | 4127664320 |
NPI Enumeration Date: | 04/01/2010 |
NPI Last Update Date: | 05/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |