Provider Demographics
NPI:1194071662
Name:AGRAWAL, VANITA (MD)
Entity type:Individual
Prefix:DR
First Name:VANITA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 E CROSSTIMBERS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-8629
Mailing Address - Country:US
Mailing Address - Phone:713-486-8550
Mailing Address - Fax:
Practice Address - Street 1:2620 E CROSSTIMBERS ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093
Practice Address - Country:US
Practice Address - Phone:713-486-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9932207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine