Provider Demographics
NPI:1285169284
Name:UPPAL, SURABHI (MD)
Entity type:Individual
Prefix:MS
First Name:SURABHI
Middle Name:
Last Name:UPPAL
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 1:350 W THOMAS ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:602-406-3540
Mailing Address - Fax:602-406-3540
Practice Address - Street 1:6710 OXON HILL RD STE 200B
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1124
Practice Address - Country:US
Practice Address - Phone:301-292-7270
Practice Address - Fax:301-203-8248
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2022-06-28
Deactivation Date:2017-11-29
Deactivation Code:
Reactivation Date:2017-12-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD93505207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD93505Medicaid