Healthcare Provider Details

I. General information

NPI: 1760973630
Provider Name (Legal Business Name): NEHA AGRAWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06106-3300
US

IV. Provider business mailing address

99 EAST RIVER DRIVE 5TH FLOOR
EAST HATFORD CT
06108
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-5000
  • Fax:
Mailing address:
  • Phone: 860-282-0833
  • Fax: 718-226-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number72638
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: