Healthcare Provider Details

I. General information

NPI: 1467438796
Provider Name (Legal Business Name): NEMISHH MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PEOPLES PLZ SUITE 201
NEWARK DE
19702-5707
US

IV. Provider business mailing address

1400 PEOPLES PLZ SUITE 201
NEWARK DE
19702-5707
US

V. Phone/Fax

Practice location:
  • Phone: 302-392-2200
  • Fax: 302-392-2226
Mailing address:
  • Phone: 302-392-2200
  • Fax: 302-392-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10007003
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: