Healthcare Provider Details

I. General information

NPI: 1750487385
Provider Name (Legal Business Name): UMA SURYADEVARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

3687 MT DIABLO BLVD SUITE 200
LAFAYETTE CA
94549-3717
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-1591
  • Fax:
Mailing address:
  • Phone: 916-854-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA79095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: