Provider Demographics
NPI:1922027994
Name:AGRAWAL, UDAYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:UDAYAN
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 1:4909 SABAL LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4459
Mailing Address - Country:US
Mailing Address - Phone:941-323-0463
Mailing Address - Fax:
Practice Address - Street 1:4909 SABAL LAKE CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4459
Practice Address - Country:US
Practice Address - Phone:941-323-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME814182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680089100Medicaid
H28327Medicare UPIN
51759ZMedicare ID - Type Unspecified