Healthcare Provider Details

I. General information

NPI: 1336591106
Provider Name (Legal Business Name): KAVITA AGRAWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 HUFFMAN MILL RD STE 120
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

300 E WENDOVER AVE
GREENSBORO NC
27401-1229
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-7725
  • Fax:
Mailing address:
  • Phone: 336-663-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number300917
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number202300976
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01095741A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number202300976
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2023-00976
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: