Healthcare Provider Details

I. General information

NPI: 1871797209
Provider Name (Legal Business Name): KRISHNAMURTHY UMAPATHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 MONTESE CT
DUBLIN CA
94568-2202
US

IV. Provider business mailing address

2117 MONTESE CT
DUBLIN CA
94568-2202
US

V. Phone/Fax

Practice location:
  • Phone: 503-758-3780
  • Fax:
Mailing address:
  • Phone: 503-758-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA113119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD27497
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: