Provider Demographics
NPI:1881660538
Name:SHANKAR, UDAY TR (MD)
Entity Type:Individual
Prefix:DR
First Name:UDAY
Middle Name:TR
Last Name:SHANKAR
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 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9466
Mailing Address - Country:US
Mailing Address - Phone:606-439-3952
Mailing Address - Fax:606-439-0154
Practice Address - Street 1:200 MEDICAL CENTER DR STE 3N
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9478
Practice Address - Country:US
Practice Address - Phone:606-439-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27169207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64271695Medicaid
KY0258402Medicare PIN
0258402Medicare ID - Type Unspecified
KYE78045Medicare UPIN