Provider Demographics
NPI:1871627331
Name:PAGEDAR, UJWALA (MD, CIC)
Entity type:Individual
Prefix:MRS
First Name:UJWALA
Middle Name:
Last Name:PAGEDAR
Suffix:
Gender:F
Credentials:MD, CIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 GREENSPIRE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7956
Mailing Address - Country:US
Mailing Address - Phone:937-286-6314
Mailing Address - Fax:
Practice Address - Street 1:520 N FALKENBURG RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7884
Practice Address - Country:US
Practice Address - Phone:813-422-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091261207R00000X
FLME152782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2980645Medicaid
OHPA4273241OtherMEDICARE PTAN
OH2980645Medicaid