Provider Demographics
NPI:1477554244
Name:AGRAWAL, NARENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4323
Mailing Address - Country:US
Mailing Address - Phone:765-962-0823
Mailing Address - Fax:765-966-0773
Practice Address - Street 1:1614 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4323
Practice Address - Country:US
Practice Address - Phone:765-962-0823
Practice Address - Fax:765-966-0773
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200104950AMedicaid
IN000000109016OtherBLUESHIELDREID HOSP EKG
IN200104950Medicaid
IN110151459Medicare Oscar/Certification
IN179520AMedicare ID - Type Unspecified
IN200104950Medicaid
G36553Medicare UPIN