Basic Information
| Provider Information | |||||||||
| NPI: | 1871574830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGRAWAL | ||||||||
| FirstName: | SANGEETA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 BRUBAKER DR | ||||||||
| Address2: | #1, DIGESTIVE SPECIALISTS INC | ||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454293588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372932169 | ||||||||
| FaxNumber: | 9372972203 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 BRUBAKER DR | ||||||||
| Address2: | #1, DIGESTIVE SPECIALISTS INC | ||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454293588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372932169 | ||||||||
| FaxNumber: | 9372972203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 10/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 35081720A | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 2478297 | 05 | OH | MEDICAID |