Healthcare Provider Details

I. General information

NPI: 1356503593
Provider Name (Legal Business Name): SATYANISTH TANDON AGRAWAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N MILITARY HWY STE 100
NORFOLK VA
23502-3652
US

IV. Provider business mailing address

190 CAMPUS BLVD STE 300
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 888-236-2263
  • Fax: 757-390-4551
Mailing address:
  • Phone: 540-667-1244
  • Fax: 540-667-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number93564
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102206444
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: