Provider Demographics
NPI:1790941318
Name:AGRAWAL, RUCHITA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUCHITA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 LINN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3842
Mailing Address - Country:US
Mailing Address - Phone:502-589-8600
Mailing Address - Fax:502-589-8771
Practice Address - Street 1:708 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2043
Practice Address - Country:US
Practice Address - Phone:502-589-8926
Practice Address - Fax:502-589-8771
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45133207QB0002X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program