Provider Demographics
NPI:1104186691
Name:MANISH UPADHYAY, MD, INC
Entity Type:Organization
Organization Name:MANISH UPADHYAY, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-786-6727
Mailing Address - Street 1:508 GIBSON DR
Mailing Address - Street 2:SUITE NO 270
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5794
Mailing Address - Country:US
Mailing Address - Phone:916-786-6727
Mailing Address - Fax:916-786-6748
Practice Address - Street 1:508 GIBSON DR
Practice Address - Street 2:SUITE NO 270
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5794
Practice Address - Country:US
Practice Address - Phone:916-786-6727
Practice Address - Fax:916-786-6748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52329207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty