Healthcare Provider Details

I. General information

NPI: 1104867217
Provider Name (Legal Business Name): HEALTHRISE LOTUS CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307,BALTIMORE AVE. 212
COLLEGE PARK MD
20740
US

IV. Provider business mailing address

7307,BALTIMORE AVE. 212
COLLEGE PARK MD
20740
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-1515
  • Fax: 301-779-3685
Mailing address:
  • Phone: 301-699-1515
  • Fax: 301-779-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. VIBHAKAR J MODY
Title or Position: OWNER
Credential: M.D.
Phone: 301-699-1515