Provider Demographics
NPI:1962593582
Name:UDAPI, SHRINIVAS R (MD)
Entity type:Individual
Prefix:DR
First Name:SHRINIVAS
Middle Name:R
Last Name:UDAPI
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 1:7350 VAN DUSEN ROAD
Mailing Address - Street 2:SUITE #380
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5231
Mailing Address - Country:US
Mailing Address - Phone:301-776-6514
Mailing Address - Fax:301-776-6592
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:SUITE # 380
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5263
Practice Address - Country:US
Practice Address - Phone:301-776-6514
Practice Address - Fax:301-776-6592
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD767551800Medicaid
MD767551800Medicaid
MD176144Medicare ID - Type Unspecified