Provider Demographics
NPI:1457667107
Name:ANIL UBEROI MD, PA
Entity Type:Organization
Organization Name:ANIL UBEROI MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNINA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-366-1101
Mailing Address - Street 1:1507 NEAR THICKET LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21153-0667
Mailing Address - Country:US
Mailing Address - Phone:410-366-1101
Mailing Address - Fax:410-366-0897
Practice Address - Street 1:4419 FALLS RD
Practice Address - Street 2:SUITE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1226
Practice Address - Country:US
Practice Address - Phone:410-366-1101
Practice Address - Fax:410-366-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD271621600Medicaid
MD8675Medicare PIN
MDB69812Medicare UPIN