Provider Demographics
NPI:1932362399
Name:ULLAL, JAGDEESH
Entity type:Individual
Prefix:
First Name:JAGDEESH
Middle Name:
Last Name:ULLAL
Suffix:
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 1:3601 5TH AVE STE 3B
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 5TH AVE STE 3B
Practice Address - Street 2:SUITE 120
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3403
Practice Address - Country:US
Practice Address - Phone:412-586-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462792207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherUNITED HEALTH CARE/MAMSI
VAPAROtherCIGNA
VAPAROtherVA HEALTH NETWORK
NC5914790Medicaid
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherMULTIPLAN
VA407913OtherANTHEM BC/BS
VA-033OtherTRICARE/CHAMPUS
VA1932362399Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherAETNA
VA10060930OtherOPTIMA HEALTH
VAPAROtherCORVEL/CORCARE
VAPAROtherVA PREMIER HEALTH
VAPAROtherVA HEALTH NETWORK
VAPAROtherVA PREMIER HEALTH