Healthcare Provider Details

I. General information

NPI: 1699246785
Provider Name (Legal Business Name): BABITA MAHAPATRA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HOSPITAL DR
CHEVERLY MD
20785-1194
US

IV. Provider business mailing address

8808 STONEHAVEN CT
POTOMAC MD
20854-3632
US

V. Phone/Fax

Practice location:
  • Phone: 301-583-3340
  • Fax: 301-583-3350
Mailing address:
  • Phone: 202-374-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberCO1934
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: