MEDICARE: DR. ASHUTOSH MAHAPATRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A2900X	Neurocritical Care Physician	35.139839	OH
2	2084N0400X	Neurology Physician	47797	TX
3	2084V0102X	Vascular Neurology Physician	47797	TX
4	2085N0700X	Neuroradiology Physician	47797	TX
5	2084A2900X	Neurocritical Care Physician	47797	TX

General Provider Information

NPI Number	:	1750700522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHUTOSH MAHAPATRA MD

Provider Business Mailing Address
First Line	:	6431 FANNIN ST STE MSB 7044
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 FANNIN ST STE MSB 7044
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	09/10/2022

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