Healthcare Provider Details

I. General information

NPI: 1841499530
Provider Name (Legal Business Name): ESWAR MOPARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 MOUNT PLEASANT BLVD SE
ROANOKE VA
24014-3632
US

IV. Provider business mailing address

3324 CIRCLE BROOK DR APT D
ROANOKE VA
24018-8255
US

V. Phone/Fax

Practice location:
  • Phone: 540-427-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: