Provider Demographics
NPI:1740613330
Name:NEELAM T. UPPAL, MD
Entity type:Organization
Organization Name:NEELAM T. UPPAL, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-547-5232
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-1002
Mailing Address - Country:US
Mailing Address - Phone:727-547-5232
Mailing Address - Fax:
Practice Address - Street 1:5840 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3250
Practice Address - Country:US
Practice Address - Phone:727-547-5232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QM2500X
FLME59800261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251201700Medicaid
FLE0867Medicare PIN