Provider Demographics
NPI:1871661041
Name:UTHAMAN, UDAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:UDAY
Middle Name:S
Last Name:UTHAMAN
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:PO BOX 8252
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19714-8252
Mailing Address - Country:US
Mailing Address - Phone:302-737-0800
Mailing Address - Fax:302-738-8169
Practice Address - Street 1:2055 LIMESTONE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5536
Practice Address - Country:US
Practice Address - Phone:302-737-0800
Practice Address - Fax:302-738-4914
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05838200207Q00000X
DEC1-0004306208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0849086001OtherAMERIHEALTH NJ
DE1000002346OtherDPCI
DE223661501OtherBCBS FEP DE
DE0000561501Medicaid
NJ6361609Medicaid
NJSA000001920OtherAMERICHOICE NJ
DE2641132000OtherAMERIHEALTH
DE1000002346OtherDPCI
NJF86330Medicare UPIN
DE181856Medicare PIN