Provider Demographics
NPI:1053318097
Name:DANDADE, USHA P (MD)
Entity Type:Individual
Prefix:
First Name:USHA
Middle Name:P
Last Name:DANDADE
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 1:615 E SCHUSTER AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4360
Mailing Address - Country:US
Mailing Address - Phone:915-533-8261
Mailing Address - Fax:915-544-1709
Practice Address - Street 1:615 E SCHUSTER AVE
Practice Address - Street 2:STE 8
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4360
Practice Address - Country:US
Practice Address - Phone:915-533-8261
Practice Address - Fax:915-544-1709
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22110Medicare UPIN
TX00AD58Medicare ID - Type Unspecified