Healthcare Provider Details

I. General information

NPI: 1205933850
Provider Name (Legal Business Name): POORNIMA UPADHYAYA PANDELLAPALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POORNIMA UPADHYAYA M.D.

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

10204 COLVIN RUN RD
GREAT FALLS VA
22066-1830
US

V. Phone/Fax

Practice location:
  • Phone: 202-677-6038
  • Fax:
Mailing address:
  • Phone: 703-629-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036167795
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101243810
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD037507
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: