Provider Demographics
NPI:1811023542
Name:MOPARTY, BHAVANI (MD)
Entity type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:
Last Name:MOPARTY
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 1:1717 S ORANGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2946
Mailing Address - Country:US
Mailing Address - Phone:321-841-4344
Mailing Address - Fax:321-843-1753
Practice Address - Street 1:1717 S ORANGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:321-841-4344
Practice Address - Fax:321-843-1753
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME167346207RG0100X
TXM6780207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123483900Medicaid
TXM6780OtherMEDICAL LICENSE
TXH49572Medicare UPIN