Provider Demographics
NPI:1619183522
Name:NAMBIAR, UMA EDAYLLAM (MBBS)
Entity Type:Individual
Prefix:DR
First Name:UMA
Middle Name:EDAYLLAM
Last Name:NAMBIAR
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6937 LAUREL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4461
Mailing Address - Country:US
Mailing Address - Phone:860-422-0151
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST STE 400AB
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4909
Practice Address - Country:US
Practice Address - Phone:817-927-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449761208000000X
CT046825208000000X
TXR5605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics