Provider Demographics
NPI:1700881562
Name:PULIPAKA, UMA (MD)
Entity Type:Individual
Prefix:
First Name:UMA
Middle Name:
Last Name:PULIPAKA
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:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-1432
Mailing Address - Country:US
Mailing Address - Phone:903-757-7056
Mailing Address - Fax:903-757-7260
Practice Address - Street 1:713 N 4TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5412
Practice Address - Country:US
Practice Address - Phone:903-757-7056
Practice Address - Fax:903-757-7260
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL46602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152867101Medicaid
TXH66023Medicare UPIN
TX8671B7Medicare ID - Type Unspecified