Healthcare Provider Details

I. General information

NPI: 1306280342
Provider Name (Legal Business Name): CHARU AGRAWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CAMBRIDGE STREET 10TH FLOOR
HOUSTON TX
77030-4202
US

IV. Provider business mailing address

ONE BAYLOR PLAZA, BCM187 HARRIS COUNTY
HOUSTON TX
77030-4202
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-3750
  • Fax: 713-798-4693
Mailing address:
  • Phone: 713-798-4508
  • Fax: 713-798-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4505
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberR4505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: