Healthcare Provider Details

I. General information

NPI: 1093244378
Provider Name (Legal Business Name): RAGHAV AGGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: N/A N/A MD

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 STRAWBERRY HILL CT 4TH FL, STE 6
STAMFORD CT
06902-2594
US

IV. Provider business mailing address

32 STRAWBERRY HILL CT 4TH FL, STE 6
STAMFORD CT
06902-2594
US

V. Phone/Fax

Practice location:
  • Phone: 203-977-2566
  • Fax: 203-977-2568
Mailing address:
  • Phone: 203-977-2566
  • Fax: 203-977-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number066279
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: