Provider Demographics
NPI:1447350335
Name:UDYAVAR, KISHORE (MD)
Entity type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:
Last Name:UDYAVAR
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 1:2703 HEAVEN WOOD CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2008
Mailing Address - Country:US
Mailing Address - Phone:410-465-7837
Mailing Address - Fax:
Practice Address - Street 1:9600 N POINT RD
Practice Address - Street 2:
Practice Address - City:FORT HOWARD
Practice Address - State:MD
Practice Address - Zip Code:21052-3050
Practice Address - Country:US
Practice Address - Phone:410-477-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine