Provider Demographics
NPI:1336311661
Name:MOHAPATRA, ROBERT A (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MOHAPATRA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WHITE HORSE PIKE STE 112
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1994
Mailing Address - Country:US
Mailing Address - Phone:856-547-0539
Mailing Address - Fax:
Practice Address - Street 1:243 HURFFVILLE CROSSKEYS RD STE 101
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4011
Practice Address - Country:US
Practice Address - Phone:856-582-2000
Practice Address - Fax:856-582-2061
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08370600207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0170038Medicaid
NJ0170038Medicaid