Provider Demographics
NPI:1801024542
Name:UTTAM TRIPATHY MD PA
Entity Type:Organization
Organization Name:UTTAM TRIPATHY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:UTTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-232-1908
Mailing Address - Street 1:PO BOX 540088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-0088
Mailing Address - Country:US
Mailing Address - Phone:713-850-1190
Mailing Address - Fax:
Practice Address - Street 1:16605 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 575 MOB 3
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3545
Practice Address - Country:US
Practice Address - Phone:281-232-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613240Medicare PIN