Provider Demographics
NPI:1407891039
Name:MOHANTY, ARUN K (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUN
Middle Name:K
Last Name:MOHANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 W GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1427
Mailing Address - Country:US
Mailing Address - Phone:215-235-9200
Mailing Address - Fax:877-876-2588
Practice Address - Street 1:445 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1427
Practice Address - Country:US
Practice Address - Phone:215-235-9200
Practice Address - Fax:877-876-2588
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037130L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA60291Medicare ID - Type UnspecifiedMEDICARE ID