Healthcare Provider Details

I. General information

NPI: 1942944558
Provider Name (Legal Business Name): GAURAV AGRAWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST
TOLEDO OH
43608-2603
US

IV. Provider business mailing address

3572 RUE ROYAL
MOBILE AL
36693-2520
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-3232
  • Fax:
Mailing address:
  • Phone: 251-382-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35C.004128
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV8190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: