Healthcare Provider Details

I. General information

NPI: 1427707835
Provider Name (Legal Business Name): JITI M. UPPUGUNDURI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 PRAIRIE AVE
PROVIDENCE RI
02905-1928
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0570
  • Fax: 401-444-0427
Mailing address:
  • Phone: 401-780-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number1028343
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO01472
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: