=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740613330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEELAM T. UPPAL, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2013
-----------------------------------------------------
Last Update Date | 08/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5840 PARK BLVD N
-----------------------------------------------------
City | PINELLAS PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33781-3250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-547-5232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1002
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33779-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-547-5232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | NEELAM T UPPAL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 727-547-5232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number | ME59800
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------