Provider Demographics
NPI:1407891872
Name:MOHAPATRA, TAPTI (PA C)
Entity Type:Individual
Prefix:
First Name:TAPTI
Middle Name:
Last Name:MOHAPATRA
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 LEHIGH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3880
Mailing Address - Country:US
Mailing Address - Phone:610-628-8413
Mailing Address - Fax:610-628-8434
Practice Address - Street 1:1501 LEHIGH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3880
Practice Address - Country:US
Practice Address - Phone:610-628-8413
Practice Address - Fax:610-628-8434
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052436363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA522325498OtherTAX ID
PA108374V8GMedicare PIN