Healthcare Provider Details

I. General information

NPI: 1689692550
Provider Name (Legal Business Name): UPMA DHINGRA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25109 DETROIT RD SUITE 325
WESTLAKE OH
44145-2551
US

IV. Provider business mailing address

25109 DETROIT RD SUITE 325
WESTLAKE OH
44145-2551
US

V. Phone/Fax

Practice location:
  • Phone: 440-366-5600
  • Fax: 440-366-6766
Mailing address:
  • Phone: 440-366-5600
  • Fax: 440-366-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. UPMA DHINGRA
Title or Position: OWNER
Credential: MD
Phone: 440-366-5600