1619224417 NPI number — DR. RADHA SAURABH MEHTA M.D

Table of content: DR. RADHA SAURABH MEHTA M.D (NPI 1619224417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619224417 NPI number — DR. RADHA SAURABH MEHTA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
RADHA
Provider Middle Name:
SAURABH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOTECHA
Provider Other First Name:
RADHA
Provider Other Middle Name:
KANTILAL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619224417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12333 NE 130TH LN STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-7467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-899-0555
Provider Business Mailing Address Fax Number:
425-899-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12040 NE 128TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  61062720 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 252349 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)