1497732424 NPI number — ASHWINKUMAR S MEHTA MD

Table of content: ASHWINKUMAR S MEHTA MD (NPI 1497732424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497732424 NPI number — ASHWINKUMAR S MEHTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
ASHWINKUMAR
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEHTA
Provider Other First Name:
ASHWIN
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497732424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3709 W HAMILTION AVE
Provider Second Line Business Mailing Address:
#5
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-4015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-932-4430
Provider Business Mailing Address Fax Number:
813-932-4250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3709 W HAMILTION AVE
Provider Second Line Business Practice Location Address:
#5
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-4015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-932-4430
Provider Business Practice Location Address Fax Number:
813-932-4250
Provider Enumeration Date:
12/30/2005

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: 207RG0100X , with the licence number:  ME0047762 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 045108800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118907200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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