Basic Information
| Provider Information | |||||||||
| NPI: | 1689873457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UPADHYAY | ||||||||
| FirstName: | ASHISH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4437 STATE ROUTE 159 | ||||||||
| Address2: | SUITE G15 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794598 | ||||||||
| FaxNumber: | 7407794599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 09/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2006024352 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 45433 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 208D00000X | 45433 | KY | N | Allopathic & Osteopathic Physicians | General Practice | 207X00000X | 54595 | CT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7100211460 | 05 | KY | MEDICAID | 775163 | 01 | KY | ANTHEM- NLSC | OTHER | 201109830 | 05 | IN | MEDICAID | K051260 | 01 | KY | MEDICARE- NLSC | OTHER |