Provider Demographics
NPI:1982708467
Name:AGRAWAL, RAM B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAM
Middle Name:B
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 1:1500 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2800
Mailing Address - Country:US
Mailing Address - Phone:518-272-0028
Mailing Address - Fax:518-272-4859
Practice Address - Street 1:1500 2ND AVE
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2800
Practice Address - Country:US
Practice Address - Phone:518-272-0028
Practice Address - Fax:518-272-4859
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109783207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00478208Medicaid
NYB82558Medicare UPIN