Provider Demographics
NPI:1447237243
Name:MOHAPATRA, PRAMODA KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:PRAMODA
Middle Name:KUMAR
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 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:215 FM 1488 ROAD
Practice Address - Street 2:HEALTH POINT HEMPSTEAD
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-9998
Practice Address - Country:US
Practice Address - Phone:979-826-8200
Practice Address - Fax:979-826-8210
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1635237-08Medicaid
TX3410037-01OtherTPI HEALTH POINT HEMPSTEAD
TXL7280OtherSTATE LICENSE
TX1649689274OtherHEALTH POINT HEMPSTEAD - FACILITY NPI
TX1635211001Medicaid
TX1821185299OtherBVCAA, INC. - AGENCY NPI
TX74-1868OtherPTAN HEALTH POINT HEMPSTEAD
TXL7280OtherSTATE LICENSE
TX1635237-08Medicaid