Provider Demographics
NPI:1649531500
Name:MAHAPATRA, RAHUL (DO)
Entity type:Individual
Prefix:
First Name:RAHUL
Middle Name:
Last Name:MAHAPATRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 IRVING AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1685
Mailing Address - Country:US
Mailing Address - Phone:315-464-9360
Mailing Address - Fax:315-464-9361
Practice Address - Street 1:725 IRVING AVE STE 314
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1685
Practice Address - Country:US
Practice Address - Phone:315-464-9360
Practice Address - Fax:315-464-9361
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY278638207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400125558Medicare PIN