Provider Demographics
NPI:1548317126
Name:POLIYEDATH, ANUPAMA (MD)
Entity type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:POLIYEDATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:7202 N MILLBROOK AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3341
Practice Address - Country:US
Practice Address - Phone:559-450-4463
Practice Address - Fax:559-450-4462
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55333208M00000X, 207R00000X
IL125048244207R00000X
NH13324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH000350501Medicare PIN