Provider Demographics
NPI:1871631440
Name:UPADHYA, GOPALAKRISHNA KADIYALI (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPALAKRISHNA
Middle Name:KADIYALI
Last Name:UPADHYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GOPAL
Other - Middle Name:K
Other - Last Name:UPADHYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:510 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3217
Mailing Address - Country:US
Mailing Address - Phone:914-682-1752
Mailing Address - Fax:914-682-1752
Practice Address - Street 1:510 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3217
Practice Address - Country:US
Practice Address - Phone:914-682-1752
Practice Address - Fax:914-682-1752
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1455832084P0800X
CT535902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98810Medicare UPIN
A98810Medicare UPIN
NY00702694Medicaid
07D151Medicare ID - Type Unspecified
NY145583OtherMEDICAL LICENSE