Provider Demographics
NPI:1700826716
Name:UPTMOR, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:UPTMOR
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:630 EATON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2767
Practice Address - Country:US
Practice Address - Phone:513-867-2270
Practice Address - Fax:513-867-2581
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044935U207P00000X
IN01068889207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000317078OtherBCBS
000000384825OtherBCBS UPPER VALLEY
OH0570832Medicaid
IN201031270Medicaid
IL036112487-1Medicaid
P00190960OtherRAIL ROAD MEDICARE
P00224120OtherRR MEDICARE HEARTLAND
UP4126723Medicare PIN
INP01106125Medicare PIN
P00224120OtherRR MEDICARE HEARTLAND
OHUP4126726Medicare PIN
ILA79887Medicare UPIN
OH0570832Medicaid
ILK16554Medicare PIN