Provider Demographics
NPI:1043623861
Name:KRISHNAMURTHY UMAPATHY M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KRISHNAMURTHY UMAPATHY M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNAMURTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:UMAPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-758-3780
Mailing Address - Street 1:2117 MONTESE CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2202
Mailing Address - Country:US
Mailing Address - Phone:503-758-3780
Mailing Address - Fax:
Practice Address - Street 1:2117 MONTESE CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2202
Practice Address - Country:US
Practice Address - Phone:503-758-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113119207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty