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General NPI Number Information
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NPI Number | 1972561157
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Entity Type | Individual
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Provider Name | SANJIB P MOHANTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 2015 RANDOLPH RD STE 208
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City | CHARLOTTE
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State | NC
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Zip | 28207-1241
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Country | US
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Telephone | 704-377-4009
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 497
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City | HUNTERSVILLE
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State | NC
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Zip | 28070-0497
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Country | US
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Telephone | 704-377-4009
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 200200575
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License Number State | NC
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