Healthcare Provider Details

I. General information

NPI: 1235293325
Provider Name (Legal Business Name): NEIL JAGDISH MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVENUE, SUITE 300
SAN FRANCISCO CA
94117
US

IV. Provider business mailing address

350 PARNASSUS AVENUE, SUITE 300
SAN FRANCISCO CA
94117
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7773
  • Fax: 415-353-2407
Mailing address:
  • Phone: 415-353-7773
  • Fax: 415-353-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT188611
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA107002
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA107002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: