Provider Demographics
NPI:1215000427
Name:MOHANTY, NIVEDITA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:
Last Name:MOHANTY
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 1:2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANE UNIT
Mailing Address - Street 2:KAISER PERMANENT MID ATLANTIC PERMANANETE METICAL GROUP
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:201 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4518
Practice Address - Country:US
Practice Address - Phone:703-237-4020
Practice Address - Fax:703-536-1400
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056434207Q00000X
VA0101229818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40956Medicare UPIN
008346M92Medicare ID - Type Unspecified