Healthcare Provider Details

I. General information

NPI: 1760400634
Provider Name (Legal Business Name): AMI MEHRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

9 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-4531
  • Fax: 978-256-1377
Mailing address:
  • Phone: 978-256-4531
  • Fax: 978-256-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number227926
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number235779
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number227926
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number14297
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: