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General NPI Number Information
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NPI Number | 1003803594
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Entity Type | Individual
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Provider Name | UMA BALLAVA MISHRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 2565 ROUTE 9W
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City | CORNWALL
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State | NY
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Zip | 12518-1309
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Country | US
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Telephone | 845-534-4700
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Fax | 845-534-4800
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Provider Business Mailing Address
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Address Line | 2565 ROUTE 9W
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City | CORNWALL
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State | NY
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Zip | 12518-1309
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Country | US
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Telephone | 845-534-4700
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Fax | 845-534-4800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1356911
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License Number State | NY
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