Provider Demographics
NPI:1629098413
Name:AGGARWALA, GAURAV (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:AGGARWALA
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 1:119 MEDICAL PARK LN STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4980
Mailing Address - Country:US
Mailing Address - Phone:936-277-1000
Mailing Address - Fax:
Practice Address - Street 1:119 MEDICAL PARK LN STE D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4980
Practice Address - Country:US
Practice Address - Phone:936-277-1000
Practice Address - Fax:936-994-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7636207R00000X, 207RC0000X
IA35576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine