Provider Demographics
NPI:1811170434
Name:ARUN K MOHANTY MD, PC
Entity type:Organization
Organization Name:ARUN K MOHANTY MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-425-5400
Mailing Address - Street 1:1462 HANCOCK LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1119
Mailing Address - Country:US
Mailing Address - Phone:215-425-5400
Mailing Address - Fax:
Practice Address - Street 1:135 E LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1011
Practice Address - Country:US
Practice Address - Phone:215-425-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037130L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030959Medicare PIN