Provider Demographics
NPI:1588649701
Name:UPADHYAY, ASIT P (DO)
Entity Type:Individual
Prefix:DR
First Name:ASIT
Middle Name:P
Last Name:UPADHYAY
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 LEMOYNE SQUARE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043
Mailing Address - Country:US
Mailing Address - Phone:717-718-9459
Mailing Address - Fax:717-718-9760
Practice Address - Street 1:1600 6TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2626
Practice Address - Country:US
Practice Address - Phone:717-718-9459
Practice Address - Fax:717-718-9760
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 007929L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007396610 003Medicaid
F46777Medicare UPIN
PA444680Medicare ID - Type Unspecified