Provider Demographics
NPI:1003985235
Name:UPADHYAY, JYOTI (MD)
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:UPADHYAY
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:PO BOX 741593
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1593
Mailing Address - Country:US
Mailing Address - Phone:757-668-7866
Mailing Address - Fax:757-668-7883
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7878
Practice Address - Fax:757-668-7883
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012426372088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908034Medicaid
VA338953OtherANTHEM
NY02278128Medicaid
VA1003985235Medicaid
VA311610834OtherTRICARE
VA10025466OtherOPTIMA
VA016408C41Medicare PIN
NC5908034Medicaid