Provider Demographics
NPI:1215740782
Name:UPSHUR, MICHAEL STEVEN SR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:UPSHUR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607A WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-2201
Mailing Address - Country:US
Mailing Address - Phone:610-803-3797
Mailing Address - Fax:
Practice Address - Street 1:607A WILLOW WAY
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-2201
Practice Address - Country:US
Practice Address - Phone:610-803-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)