Provider Demographics
NPI:1548203839
Name:PUREWAL, UPLEKH (MD)
Entity Type:Individual
Prefix:
First Name:UPLEKH
Middle Name:
Last Name:PUREWAL
Suffix:
Gender:M
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:PO BOX 33465
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0612
Mailing Address - Country:US
Mailing Address - Phone:856-779-7774
Mailing Address - Fax:856-779-0211
Practice Address - Street 1:9815 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1011
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:856-779-0211
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427900207LP2900X, 208VP0000X
NJ25MA09478200207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015057900001Medicaid
PA1015057900001Medicaid
I48222Medicare UPIN
PA097405ZJGWMedicare PIN