Healthcare Provider Details

I. General information

NPI: 1356703417
Provider Name (Legal Business Name): ALEXANDER MOHAPATRA M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE RM 987
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

513 PARNASSUS AVE BOX 0111
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1528
  • Fax:
Mailing address:
  • Phone: 415-476-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA153442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: