Provider Demographics
NPI:1013102821
Name:RAGHU P. UPENDER, MD, NEUROHEALTH PC
Entity type:Organization
Organization Name:RAGHU P. UPENDER, MD, NEUROHEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:PISHKA
Authorized Official - Last Name:UPENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-461-5946
Mailing Address - Street 1:1805 N JACKSON ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2290
Mailing Address - Country:US
Mailing Address - Phone:931-461-5946
Mailing Address - Fax:931-461-5948
Practice Address - Street 1:1805 N JACKSON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2290
Practice Address - Country:US
Practice Address - Phone:931-461-5946
Practice Address - Fax:931-461-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39248261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727285Medicare PIN