Healthcare Provider Details

I. General information

NPI: 1144595414
Provider Name (Legal Business Name): MUGDHA AGRAWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 115
VOORHEES NJ
08043-4509
US

IV. Provider business mailing address

2301 E EVESHAM RD STE 115
VOORHEES NJ
08043-4509
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-5005
  • Fax: 212-731-5210
Mailing address:
  • Phone: 856-424-5005
  • Fax: 212-731-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA10843000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: