Provider Demographics
NPI:1386639623
Name:MOHANTY, RAJASHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJASHREE
Middle Name:
Last Name:MOHANTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJASHREE
Other - Middle Name:
Other - Last Name:MOHANTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1725 COLONIAL DR
Mailing Address - Street 2:APT 25
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-8991
Mailing Address - Country:US
Mailing Address - Phone:317-496-4836
Mailing Address - Fax:
Practice Address - Street 1:1725 COLONIAL DR
Practice Address - Street 2:APT 25
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-8991
Practice Address - Country:US
Practice Address - Phone:317-496-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-10-20
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
IL036.137506208000000X
ORMD172318208000000X
IN01033041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100188900Medicaid