Healthcare Provider Details

I. General information

NPI: 1093773186
Provider Name (Legal Business Name): MRIDU B AGARWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N MAIN ST
WARSAW NY
14569-1015
US

IV. Provider business mailing address

408 N MAIN ST
WARSAW NY
14569-1015
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2219
  • Fax:
Mailing address:
  • Phone: 585-786-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number143330
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: