Provider Demographics
NPI:1801244454
Name:DR. UMABALA PASUPALA, PLLC
Entity type:Organization
Organization Name:DR. UMABALA PASUPALA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:UMABALA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASUPALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-816-7014
Mailing Address - Street 1:6815 KOALA DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310
Mailing Address - Country:US
Mailing Address - Phone:336-816-7014
Mailing Address - Fax:
Practice Address - Street 1:6815 KOALA DRIVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310
Practice Address - Country:US
Practice Address - Phone:336-816-7014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-02018207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty