Healthcare Provider Details

I. General information

NPI: 1548203839
Provider Name (Legal Business Name): UPLEKH PUREWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 ROOSEVELT BLVD
PHILADELPHIA PA
19114-1011
US

IV. Provider business mailing address

PO BOX 33465
BELFAST ME
04915-0612
US

V. Phone/Fax

Practice location:
  • Phone: 888-985-2727
  • Fax: 856-779-0211
Mailing address:
  • Phone: 856-779-7774
  • Fax: 856-779-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD427900
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA09478200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA09478200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD427900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: