Provider Demographics
NPI:1629198783
Name:UPPALURI, LAKSHMI P (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:P
Last Name:UPPALURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 FRENCH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1935
Mailing Address - Country:US
Mailing Address - Phone:732-235-7899
Mailing Address - Fax:
Practice Address - Street 1:89 FRENCH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1935
Practice Address - Country:US
Practice Address - Phone:732-235-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA084753002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113265OtherMEDICAL LICENSE
NJ0188174Medicaid
MA225465OtherMEDICAL LICENSE
MA225465OtherMEDICAL LICENSE
NJ194023C54Medicare PIN