Provider Demographics
NPI:1427058544
Name:AGRAWAL, INA U (MD)
Entity type:Individual
Prefix:DR
First Name:INA
Middle Name:U
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 1:1614 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4323
Mailing Address - Country:US
Mailing Address - Phone:765-962-0823
Mailing Address - Fax:765-966-0773
Practice Address - Street 1:1614 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4323
Practice Address - Country:US
Practice Address - Phone:765-962-0823
Practice Address - Fax:765-966-0773
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200312110Medicaid
IN903830LLMedicare ID - Type UnspecifiedREID HOSPITAL - EKG
IN200312110Medicaid
H36444Medicare UPIN