| Dibyajiban Mahapatra,m.d.,p.c. | |
|
185 Whitesports Drive Suite No. 7 Huntsville AL 35801 | |
| (256) 883-6966 | |
| (256) 883-6432 |
| Full Name | Dibyajiban Mahapatra,m.d.,p.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 185 Whitesports Drive, Huntsville, Alabama |
| Authorized Official Name and Position | Dibyajiban Mahapatra (PHYSICIAN) |
| Authorized Official Contact | 2568836966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dibyajiban Mahapatra,m.d.,p.c. 16025 Michelle Drive Huntsville AL 35803 Ph: (256) 883-6125 | Dibyajiban Mahapatra,m.d.,p.c. 185 Whitesports Drive Suite No. 7 Huntsville AL 35801 Ph: (256) 883-6966 |
| NPI Number | 1548318645 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 09/09/2008 |
| Medicare PECOS PAC ID | 7315011962 |
|---|---|
| Medicare Enrollment ID | O20080731000203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548318645 | NPI | - | NPPES |
| 529911790 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20939 (Alabama) | Primary |
| Provider Name | Dibyajiban Mahapatra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639163769 PECOS PAC ID: 3375435175 Enrollment ID: I20040326000650 |
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