Healthcare Provider Details

I. General information

NPI: 1962507384
Provider Name (Legal Business Name): AMY GUILLET AGRAWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY RENEE GUILLET M.D.

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1483
US

IV. Provider business mailing address

4875 POTOMAC AVE NW
WASHINGTON DC
20007-1539
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-7000
  • Fax:
Mailing address:
  • Phone: 202-342-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0064752
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0064752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: