Provider Demographics
NPI:1235460726
Name:PASUPALA, UMABALA (MD)
Entity Type:Individual
Prefix:
First Name:UMABALA
Middle Name:
Last Name:PASUPALA
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 1:6815 KOALA DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310
Mailing Address - Country:US
Mailing Address - Phone:336-816-7014
Mailing Address - Fax:
Practice Address - Street 1:6815 KOALA DRIVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310
Practice Address - Country:US
Practice Address - Phone:336-816-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-02018207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty