Provider Demographics
NPI:1588851133
Name:MADHAVI UPPALAPATI MD. PA
Entity Type:Organization
Organization Name:MADHAVI UPPALAPATI MD. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:UPPALAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-829-8920
Mailing Address - Street 1:3504 LEGACY HILLS CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3198
Mailing Address - Country:US
Mailing Address - Phone:407-829-8920
Mailing Address - Fax:407-829-8921
Practice Address - Street 1:1301 S INTERNATIONAL PKWY STE 1001
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1410
Practice Address - Country:US
Practice Address - Phone:407-829-8920
Practice Address - Fax:407-829-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277857200Medicaid
FLK8988Medicare PIN