Provider Demographics
NPI:1922067834
Name:UPADYA, ANUPAMA (MD)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:UPADYA
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 1:753 HIGHWAY 466
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6340
Mailing Address - Country:US
Mailing Address - Phone:352-391-5500
Mailing Address - Fax:352-391-5501
Practice Address - Street 1:753 HIGHWAY 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6340
Practice Address - Country:US
Practice Address - Phone:352-391-5500
Practice Address - Fax:352-391-5501
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039405207R00000X, 207RP1001X
FL97830207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI03703Medicare UPIN