Provider Demographics
NPI:1275687261
Name:AMIT UPADHIAYA DO PA
Entity Type:Organization
Organization Name:AMIT UPADHIAYA DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHIAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-782-3170
Mailing Address - Street 1:PO BOX 50451
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33074-0451
Mailing Address - Country:US
Mailing Address - Phone:954-782-3170
Mailing Address - Fax:
Practice Address - Street 1:1 W SAMPLE RD STE 201
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-782-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL059136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6605Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER