Provider Demographics
NPI:1952806572
Name:UPADHYAYA, PRERANA (MD)
Entity type:Individual
Prefix:
First Name:PRERANA
Middle Name:
Last Name:UPADHYAYA
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 1:3214 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4810
Mailing Address - Country:US
Mailing Address - Phone:501-380-2280
Mailing Address - Fax:501-380-2282
Practice Address - Street 1:3214 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4810
Practice Address - Country:US
Practice Address - Phone:501-380-2280
Practice Address - Fax:501-380-2282
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2023-04-03
Deactivation Date:2023-03-27
Deactivation Code:
Reactivation Date:2023-04-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program