Provider Demographics
NPI:1336250596
Name:MOHAPATRA, SABYASACHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SABYASACHI
Middle Name:
Last Name:MOHAPATRA
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 1:7211 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2566
Mailing Address - Country:US
Mailing Address - Phone:952-846-7090
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL LN STE 100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1993
Practice Address - Country:US
Practice Address - Phone:317-745-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5469207RG0100X
OH35.129724207RG0100X
IN01083437A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143702201Medicaid
TX8970M0OtherBCBS
TX8790M0Medicare ID - Type UnspecifiedMEDICARE - ODESSA
G13219Medicare UPIN
TX8970M0OtherBCBS