Provider Demographics
NPI:1699246785
Name:MAHAPATRA, BABITA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:BABITA
Middle Name:
Last Name:MAHAPATRA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 STONEHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3632
Mailing Address - Country:US
Mailing Address - Phone:202-374-6427
Mailing Address - Fax:
Practice Address - Street 1:3003 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1194
Practice Address - Country:US
Practice Address - Phone:301-583-3340
Practice Address - Fax:301-583-3350
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCO1934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical