Provider Demographics
NPI:1104844000
Name:DASHOTTAR, NUPUR (MD)
Entity Type:Individual
Prefix:DR
First Name:NUPUR
Middle Name:
Last Name:DASHOTTAR
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 1:1200 BROOKS LN
Mailing Address - Street 2:SUITE 290
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-729-1500
Mailing Address - Fax:412-384-2462
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE 290
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-729-1500
Practice Address - Fax:412-384-2462
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066857L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017531790003Medicaid
PA080144334OtherRAILROAD MEDICARE
PA472576OtherHIGHMARK BC/BS
PA0017531790006Medicaid
PA0017531790002Medicaid
PA2158464OtherAETNA
PA00175317900015Medicaid
PA114717OtherHEALTH AMERICA
PA205924OtherUPMC
PA114717OtherHEALTH AMERICA
PA00175317900015Medicaid