Individual
SOURYA RANJAN MAHAPATRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
NASHUA CENTER FOR HEALTHY AGING, 280 MAIN ST., #210A, NASHUA, NH 03060
(603) 577-3080
Mailing address
280 MAIN ST STE 210A, NASHUA, NH 03060-2920
(603) 577-3080
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
12394
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30204441
—
NH
Enumeration date
10/06/2006
Last updated
04/05/2021
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