Provider Demographics
NPI:1730163544
Name:UPADHYAYA, NARENDRA R (MD)
Entity type:Individual
Prefix:
First Name:NARENDRA
Middle Name:R
Last Name:UPADHYAYA
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 1:2301 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3617
Mailing Address - Country:US
Mailing Address - Phone:954-986-1232
Mailing Address - Fax:954-986-1833
Practice Address - Street 1:2301 N UNIVERSITY DR
Practice Address - Street 2:STE 106
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-986-1232
Practice Address - Fax:954-986-1833
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60989207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056981000Medicaid
FL14392OtherBCBS
FL14392AMedicare PIN
F10776Medicare UPIN