Provider Demographics
NPI:1962457846
Name:MOHANTY, PRAMOD K (MD)
Entity type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:K
Last Name:MOHANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:311 VICTORIA WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-7117
Mailing Address - Country:US
Mailing Address - Phone:804-784-0365
Mailing Address - Fax:804-675-5420
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:1201 BROAD ROCK BLVD
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-675-5444
Practice Address - Fax:804-675-5420
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101023354207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease