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Organization
VERNON INTERNAL MEDICINE CLINIC INC
Active
Organization
VERNON INTERNAL MEDICINE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KANCHAN PRASAD UPADHYAY MD (BUISNESS OWNER)
(337) 238-3475
Entity
Organization
Contact information
Practice address
931 VERONE TER, SUITE A, LEESVILLE, LA 71446-4272
(337) 238-3475
(337) 238-3475
Mailing address
931 VERONE TER, SUITE A, LEESVILLE, LA 71446-4272
(337) 238-3475
(337) 238-3475
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0508695280
BLUECROSS BLUE SHEILD
LA
05
—
1578924
—
LA
01
—
36-00370
UNITED HEALTH CARE
LA
Enumeration date
07/07/2006
Last updated
03/10/2020
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