MEDICARE: SANJAY UPADHYAY M.D.

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	207Q00000X	Family Medicine Physician	253746	NY
2	207Q00000X	Family Medicine Physician	MD460862	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	253746	OTHER	NY	LICENSE#
2	MD460862	OTHER	PA	LICENSE NUMBER

General Provider Information

NPI Number	:	1538350053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY UPADHYAY M.D.

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:	2ND FLOOR TPI
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-926-9022
Fax Number	:	215-226-8286

Provider Business Practice Location Address
First Line	:	1741 FRANKFORD AVE
Second Line	:	SUITE 100A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2445
Country	:	US
Telephone Number	:	215-425-2424
Fax Number	:	215-425-0342

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	05/30/2017

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