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1649257916

NPI Code Detail

MEDICARE: DR. NIMISH MEHTA MD

MEDICARE: DR. NIMISH 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	208000000X	Pediatrics Physician	20051	WV
2	207P00000X	Emergency Medicine Physician	20051	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001718074	OTHER	WV	WV BCBS
2	1057343	OTHER	WV	WV DWC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649257916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIMISH MEHTA MD

Provider Business Mailing Address
First Line	:	3100 MACCORKLE AVE SE
Second Line	:	STE 203
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1228
Country	:	US
Telephone Number	:	304-388-1724
Fax Number	:	304-388-1721

Provider Business Practice Location Address
First Line	:	800 PENNSYLVANIA AVE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3351
Country	:	US
Telephone Number	:	304-388-2550
Fax Number	:

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	04/28/2023

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Directions to “ DR. NIMISH MEHTA MD” Practice Location

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