Provider Demographics
NPI:1205864659
Name:AGRAWAL, MAMATHA K (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMATHA
Middle Name:K
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4551 NEW BERN AVE # A100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1551
Mailing Address - Country:US
Mailing Address - Phone:984-215-4950
Mailing Address - Fax:984-215-4955
Practice Address - Street 1:4551 NEW BERN AVE # A100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1551
Practice Address - Country:US
Practice Address - Phone:984-215-4960
Practice Address - Fax:984-215-4965
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200000169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7478171OtherAETNA PPO
NCB4846OtherMEDCOST
NC010066307OtherRAILROAD MEDICARE
NC0156615OtherUHC
NC8443512OtherCIGNA
NC89127VUMedicaid
NC171525OtherWELLPATH
NC116335OtherAETNA HMO
NC127VUOtherBCBS
NC228096OtherMAMSI
NC116335OtherAETNA HMO
NC127VUOtherBCBS