Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 100103 | NY |
NPI | 1154544278 |
---|---|
Provider Name | Dr. Ravinder N Agarwal |
First Address | Ogdensburg, NY 13669 |
Second Address | Ogdensburg, NY 13669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 06/05/2015 |