Provider Demographics
NPI:1528020062
Name:SINGH-MOHAPATRA, SHERRY (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:SINGH-MOHAPATRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CENTENNIAL BLVD
Mailing Address - Street 2:BUILDING 2 SUITE 201
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4689
Mailing Address - Country:US
Mailing Address - Phone:856-325-6770
Mailing Address - Fax:856-673-4300
Practice Address - Street 1:900 CENTENNIAL BLVD
Practice Address - Street 2:BUILDING 2 SUITE 201
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4689
Practice Address - Country:US
Practice Address - Phone:856-325-6770
Practice Address - Fax:856-673-4300
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238172207R00000X
NJMA08605100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02718014Medicaid