Provider Demographics
NPI:1417938499
Name:UPADHIAYA, AMIT (DO)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:UPADHIAYA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W SAMPLE RD
Mailing Address - Street 2:#201
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3547
Mailing Address - Country:US
Mailing Address - Phone:954-782-3170
Mailing Address - Fax:954-782-3171
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:#201
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:954-782-3171
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270704700Medicaid
I11143Medicare UPIN
I11143Medicare UPIN