Individual
DR. MUGDHA MOHANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 441-8084
(508) 856-4287
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
254993
MA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
276799
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110115970A
—
MA
Enumeration date
07/22/2013
Last updated
11/16/2020
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