Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 18456 | ME |
Y | 207RG0100X | Gastroenterologist | 25131 | SC |
NPI | 1003906017 |
---|---|
Provider Name | Amit Agrawal |
First Address | Brewer, ME 04412-1006 |
Second Address | Charleston, SC 29425-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 06/10/2020 |