Provider Demographics
NPI:1336250596
Name:MOHAPATRA, SABYASACHI (MD)
Entity type:Individual
Prefix:DR
First Name:SABYASACHI
Middle Name:
Last Name:MOHAPATRA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2566
Mailing Address - Country:US
Mailing Address - Phone:952-846-7090
Mailing Address - Fax:
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-897-2770
Practice Address - Fax:732-897-3970
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5469207RG0100X
IN01083437A207RG0100X
OH35.129724207RG0100X
NJ25MA06210700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143702201Medicaid
TX8970M0OtherBCBS
TX8790M0Medicare ID - Type UnspecifiedMEDICARE - ODESSA
G13219Medicare UPIN
TX8970M0OtherBCBS