Provider Demographics
NPI:1952309460
Name:UPADHYAYULA, NAGENDRA PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:NAGENDRA
Middle Name:PRASAD
Last Name:UPADHYAYULA
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 1:1003 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1786
Mailing Address - Country:US
Mailing Address - Phone:845-471-0013
Mailing Address - Fax:
Practice Address - Street 1:1003 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1786
Practice Address - Country:US
Practice Address - Phone:845-471-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225874207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02319597Medicaid
NY02319597Medicaid
NYJ400034078Medicare PIN
NYJ400034078Medicare PIN