Provider Demographics
NPI:1184606477
Name:AGRAWAL, ALOK (MD)
Entity type:Individual
Prefix:
First Name:ALOK
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 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2170
Mailing Address - Country:US
Mailing Address - Phone:937-383-2700
Mailing Address - Fax:937-383-2722
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2170
Practice Address - Country:US
Practice Address - Phone:937-383-2700
Practice Address - Fax:937-383-2722
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH77552207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161842Medicaid
390007302OtherMEDICARE RAILROAD
390007302OtherUHC
000000074148OtherANTHEM
2273021OtherAETNA
310821503032OtherCARE SOURCE
3108215037B22OtherUNITED MINE WORKERS
D77552OtherHUMANA
000000074148OtherANTHEM
310821503032OtherCARE SOURCE
OH0896271Medicare ID - Type Unspecified