Provider Demographics
NPI:1154303592
Name:UPENDER, RAGHU P
Entity Type:Individual
Prefix:DR
First Name:RAGHU
Middle Name:P
Last Name:UPENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-322-3000
Mailing Address - Fax:615-936-0605
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-3000
Practice Address - Fax:615-936-0605
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39248204R00000X, 2084N0400X, 2084S0012X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727285Medicaid
TN4095150OtherTENNCARE
TN331101815OtherCOMMERICAL
TN4095150OtherBCBS
TN4095150OtherTENNCARE
TN3325391Medicare PIN