Provider Demographics
NPI:1700112612
Name:PERIYANAYAGAM, UMA (MD)
Entity Type:Individual
Prefix:DR
First Name:UMA
Middle Name:
Last Name:PERIYANAYAGAM
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 1:6622 FOX RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8089
Mailing Address - Country:US
Mailing Address - Phone:252-412-1838
Mailing Address - Fax:704-978-2380
Practice Address - Street 1:10115 KINCEY AVE STE 148
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6482
Practice Address - Country:US
Practice Address - Phone:704-804-4374
Practice Address - Fax:704-288-4876
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34525208000000X
NC2012-00678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics