Healthcare Provider Details

I. General information

NPI: 1194169755
Provider Name (Legal Business Name): TAPAN VIJAYKUMAR MEHTA M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR STREET HARTFORD HOSPITAL NEUROLOGY DEPT
HARTFORD CT
06106
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-3621
  • Fax:
Mailing address:
  • Phone: 860-972-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number063993
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number063993
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number063993
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: