Provider Demographics
NPI:1104867217
Name:HEALTHRISE LOTUS CARE,LLC
Entity Type:Organization
Organization Name:HEALTHRISE LOTUS CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIBHAKAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-699-1515
Mailing Address - Street 1:7307,BALTIMORE AVE.
Mailing Address - Street 2:212
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740
Mailing Address - Country:US
Mailing Address - Phone:301-699-1515
Mailing Address - Fax:301-779-3685
Practice Address - Street 1:7307,BALTIMORE AVE.
Practice Address - Street 2:212
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740
Practice Address - Country:US
Practice Address - Phone:301-699-1515
Practice Address - Fax:301-779-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty