Healthcare Provider Details

I. General information

NPI: 1699736298
Provider Name (Legal Business Name): RAJENDRA MOHAN AGRAWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 NORTH MAIN STREET
WARSAW NY
14569
US

IV. Provider business mailing address

408 NORTH MAIN STREET
WARSAW NY
14569
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2540
  • Fax: 585-786-7958
Mailing address:
  • Phone: 585-786-2540
  • Fax: 585-786-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number142026
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: