Provider Demographics
NPI:1871531764
Name:MAHAPATRO, DARSHANA (MD)
Entity type:Individual
Prefix:
First Name:DARSHANA
Middle Name:
Last Name:MAHAPATRO
Suffix:
Gender:F
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:PO BOX 95000-2705
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2705
Mailing Address - Country:US
Mailing Address - Phone:609-441-2147
Mailing Address - Fax:609-441-2107
Practice Address - Street 1:600 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5237
Practice Address - Country:US
Practice Address - Phone:732-557-8141
Practice Address - Fax:732-557-8933
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03707300207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5111803Medicaid
NJD91726Medicare UPIN
NJ679436DFSMedicare PIN