Provider Demographics
NPI:1194765867
Name:MOHAPATRA, CHITTA R (MD)
Entity type:Individual
Prefix:
First Name:CHITTA
Middle Name:R
Last Name:MOHAPATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HARRISON ST
Mailing Address - Street 2:STE 250
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-770-8600
Mailing Address - Fax:607-770-0853
Practice Address - Street 1:30 HARRISON ST
Practice Address - Street 2:STE 250
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-770-8600
Practice Address - Fax:607-770-0853
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119520207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00331122Medicaid
BB3737Medicare ID - Type Unspecified
B82436Medicare UPIN