MEDICARE: DR. COLBY C UPTEGRAFT MD, MPH, MBI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	274072	MA
2	2083C0008X	Clinical Informatics Physician	274072	MA
3	2083A0100X	Aerospace Medicine Physician	274072	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316385156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLBY C UPTEGRAFT MD, MPH, MBI

Provider Business Mailing Address
First Line	:	7700 ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2929
Country	:	US
Telephone Number	:	202-527-9636
Fax Number	:

Provider Business Practice Location Address
First Line	:	JOINT BASE ANACOSTIA-BOLLING CLINIC
Second Line	:	238 BROOKLEY AVE SW, BLDG #1300
City	:	JOINT BASE ANACOSTIA-BOLLING
State	:	DC
Zip	:	20032
Country	:	US
Telephone Number	:	202-404-5512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	04/10/2023

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