Provider Demographics
NPI:1912016718
Name:UDUPA, USHA (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:
Last Name:UDUPA
Suffix:
Gender:F
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:IMAGINE BY NORTHPOINT FORT COLLINS
Mailing Address - Street 2:3800 AUTOMATION WAY, SUITE 102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-900-5835
Mailing Address - Fax:970-387-7330
Practice Address - Street 1:3800 AUTOMATION WAY, SUITE 102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-900-5835
Practice Address - Fax:970-387-7330
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO420352084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BU8106088OtherDEA
H81901Medicare UPIN
531668Medicare ID - Type Unspecified