Provider Demographics
NPI:1760498620
Name:UPPAL, ARVINDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:ARVINDER
Middle Name:S
Last Name:UPPAL
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 1:2411 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7515
Mailing Address - Country:US
Mailing Address - Phone:662-577-6673
Mailing Address - Fax:662-537-4532
Practice Address - Street 1:1727 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3253
Practice Address - Country:US
Practice Address - Phone:662-537-4830
Practice Address - Fax:662-537-4532
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462683207Y00000X
IL036106991207Y00000X
IN036106991207Y00000X
MS22658207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS8188321Medicaid
INPENDINGMedicaid
H13344Medicare UPIN
ILL92467Medicare ID - Type Unspecified
INPENDINGMedicare PIN