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General NPI Number Information
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NPI Number | 1053874115
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Entity Type | Individual
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Provider Name | DEEP HANS MAHAPATRA
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Gender | Male
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Dates
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Enumeration Date | 04/07/2019
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 5009 HONEYGO CENTER DR STE 216
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City | PERRY HALL
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State | MD
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Zip | 21128-9842
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Country | US
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Telephone | 410-256-5858
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Fax | 410-529-2431
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Provider Business Mailing Address
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Address Line | 215 BRIGHTWATER DR
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City | LILLINGTON
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State | NC
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Zip | 27546-5156
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Country | US
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Telephone | 910-892-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H96650
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License Number State | MD
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