1831193606 NPI number — DR. BINA MEHTA MD

Table of content: DR. BINA MEHTA MD (NPI 1831193606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831193606 NPI number — DR. BINA MEHTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
BINA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831193606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 W MAIN ST
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-677-3628
Provider Business Mailing Address Fax Number:
330-677-3626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 W MAIN ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-677-3628
Provider Business Practice Location Address Fax Number:
330-677-3626
Provider Enumeration Date:
06/09/2005

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: 174400000X , with the licence number:  35072527M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 35-072527 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2082866 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2551671 . This is a "PARTNERS PHYSICIAN GROUP MEDICAID GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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