1518906056 NPI number — BHARGESH PRAMODRAY MEHTA M.D.

Table of content: LENIYA NICHOLS (NPI 1073244653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518906056 NPI number — BHARGESH PRAMODRAY MEHTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
BHARGESH
Provider Middle Name:
PRAMODRAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1518906056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 HOSPITAL RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-535-5555
Provider Business Mailing Address Fax Number:
410-535-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-535-5555
Provider Business Practice Location Address Fax Number:
410-535-5599
Provider Enumeration Date:
06/06/2006

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: 208000000X , with the licence number:  D0046264 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1020694 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870226 . This is a "ALLIANCE PPO" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".
  • Identifier: 090422 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53593501 . This is a "BC/BS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1201708 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4379 . This is a "BC/BS BLUE CHOICE" identifier . This identifiers is of the category "OTHER".




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