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General NPI Number Information
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NPI Number | 1801995915
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Entity Type | Organization
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Legal Business Name | UPPER VALLEY PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 998 S DORSET RD SUITE 301
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City | TROY
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State | OH
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Zip | 45373-4753
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Country | US
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Telephone | 937-339-5441
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Fax | 937-339-6668
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Provider Business Mailing Address
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Address Line | PO BOX 479
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City | TROY
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State | OH
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Zip | 45373-0479
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Country | US
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Telephone | 937-339-5441
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Fax | 937-339-6668
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PAMELA RADER
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Credential |
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Telephone | 937-440-7454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | OH
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