Provider Demographics
NPI:1447237243
Name:MOHAPATRA, PRAMODA K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMODA
Middle Name:K
Last Name:MOHAPATRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 UNIVERSITY DRIVE EAST - SUITE 100
Mailing Address - Street 2:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Mailing Address - City:COLLEGE
Mailing Address - State:TX
Mailing Address - Zip Code:77840
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:215 FM 1488 ROAD
Practice Address - Street 2:HEALTH POINT HEMPSTEAD
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-9998
Practice Address - Country:US
Practice Address - Phone:979-826-8200
Practice Address - Fax:979-826-8210
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2015-03-10
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Provider Licenses
StateLicense IDTaxonomies
TXL7280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1635237-08Medicaid
TX74-1868OtherPTAN HEALTH POINT HEMPSTEAD
TX1821185299OtherBVCAA, INC. - AGENCY NPI
TX1649689274OtherHEALTH POINT HEMPSTEAD - FACILITY NPI
TX3410037-01OtherTPI HEALTH POINT HEMPSTEAD
TXL7280OtherSTATE LICENSE
TX1635211001Medicaid
TXL7280OtherSTATE LICENSE
TX1635237-08Medicaid