MEDICARE: ASHOK V MEHTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	MD017615	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477515880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHOK V MEHTA MD

Provider Business Mailing Address
First Line	:	PO BOX 3953
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37602-3953
Country	:	US
Telephone Number	:	423-915-1126
Fax Number	:	423-915-0635

Provider Business Practice Location Address
First Line	:	2312 KNOB CREEK RD
Second Line	:	STE 208
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2367
Country	:	US
Telephone Number	:	423-610-1099
Fax Number	:	423-610-1166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	04/06/2012

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