Healthcare Provider Details

I. General information

NPI: 1508051301
Provider Name (Legal Business Name): SUMIT KISHORE AGRAWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WELCH ROAD
STANFORD CA
94305-5739
US

IV. Provider business mailing address

801 WELCH ROAD
STANFORD CA
94305-5739
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-6500
  • Fax: 650-725-8502
Mailing address:
  • Phone: 650-725-6500
  • Fax: 650-725-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA96359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: