Healthcare Provider Details

I. General information

NPI: 1316385156
Provider Name (Legal Business Name): COLBY C UPTEGRAFT MD, MPH, MBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOINT BASE ANACOSTIA-BOLLING CLINIC 238 BROOKLEY AVE SW, BLDG #1300
JOINT BASE ANACOSTIA-BOLLING DC
20032
US

IV. Provider business mailing address

7700 ARLINGTON BLVD
FALLS CHURCH VA
22042-2929
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-5512
  • Fax:
Mailing address:
  • Phone: 202-527-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number274072
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number274072
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number274072
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: