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1376582353

NPI Code Detail

MEDICARE: RAVI AGARWALA MD

MEDICARE: RAVI AGARWALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2012-01664	NC
2	2084A2900X	Neurocritical Care Physician	2012-01664	NC
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2012-01664	NC

General Provider Information

NPI Number	:	1376582353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI AGARWALA MD

Provider Business Mailing Address
First Line	:	3511 W MARKET ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4443
Country	:	US
Telephone Number	:	336-522-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 W MARKET ST STE 100
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4444
Country	:	US
Telephone Number	:	336-522-8999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	06/01/2023

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Directions to “ RAVI AGARWALA MD” Practice Location

Language	Start Address	Practice Location

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