Provider Demographics
NPI:1831152404
Name:DHANJAL, UPENDRA S (MD)
Entity type:Individual
Prefix:
First Name:UPENDRA
Middle Name:S
Last Name:DHANJAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MEDICAL CENTER WAY
Mailing Address - Street 2:2ND FL
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2306
Mailing Address - Country:US
Mailing Address - Phone:609-365-3100
Mailing Address - Fax:609-365-3165
Practice Address - Street 1:155 MEDICAL CENTER WAY
Practice Address - Street 2:2ND FL
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2306
Practice Address - Country:US
Practice Address - Phone:609-365-3100
Practice Address - Fax:609-365-3165
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065406L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2906338332OtherBS
MI4236497Medicaid
MI290013010OtherRR MC
MI2906338332OtherBS
MI290013010OtherRR MC