Provider Demographics
NPI:1376934059
Name:UPADHYAY, ANKIT B (MD)
Entity type:Individual
Prefix:
First Name:ANKIT
Middle Name:B
Last Name:UPADHYAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2832
Mailing Address - Country:US
Mailing Address - Phone:718-206-7708
Mailing Address - Fax:
Practice Address - Street 1:1016 TACOMA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2263
Practice Address - Country:US
Practice Address - Phone:509-837-1500
Practice Address - Fax:509-837-4908
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8376207RC0000X
VA0101281686207RC0000X
WAMD61210673207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2258793Medicaid