Provider Demographics
NPI:1952490559
Name:TANEJA UPPAL, NEELAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELAM
Middle Name:
Last Name:TANEJA UPPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEELAM
Other - Middle Name:
Other - Last Name:UPPAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779
Mailing Address - Country:US
Mailing Address - Phone:646-740-9141
Mailing Address - Fax:646-380-1220
Practice Address - Street 1:5840 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-403-0022
Practice Address - Fax:646-380-1220
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59800207N00000X, 207RI0200X, 2080P0208X, 207R00000X
NY184610207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251201700Medicaid
FLE0867Medicare PIN
FL251201700Medicaid
NJF30049Medicare UPIN
FLE0867Medicare UPIN