MEDICARE: DR. PRAMOD K MOHANTY 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	207RC0000X	Cardiovascular Disease Physician	0101023354	VA

General Provider Information

NPI Number	:	1962457846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAMOD K MOHANTY MD

Provider Business Mailing Address
First Line	:	311 VICTORIA WAY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-7117
Country	:	US
Telephone Number	:	804-784-0365
Fax Number	:	804-675-5420

Provider Business Practice Location Address
First Line	:	1250 E MARSHALL ST
Second Line	:	1201 BROAD ROCK BLVD
City	:	RICHMOND
State	:	VA
Zip	:	23298-5051
Country	:	US
Telephone Number	:	804-675-5444
Fax Number	:	804-675-5420

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/08/2007

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