Provider Demographics
NPI:1154395192
Name:AGRAWAL, STUTI S (MD)
Entity type:Individual
Prefix:DR
First Name:STUTI
Middle Name:S
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 ROUTE 9 N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3301
Mailing Address - Country:US
Mailing Address - Phone:732-625-1100
Mailing Address - Fax:732-625-1110
Practice Address - Street 1:1001 ROUTE 9 N
Practice Address - Street 2:SUITE 105
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3301
Practice Address - Country:US
Practice Address - Phone:732-625-1100
Practice Address - Fax:732-625-1110
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8087006Medicaid
NJ8087006Medicaid
H07491Medicare UPIN