Healthcare Provider Details

I. General information

NPI: 1326262635
Provider Name (Legal Business Name): NARESH CHANDRA MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BLUEGRASS LANE
SHREWSBURY MA
01545-4201
US

IV. Provider business mailing address

14 BLUEGRASS LN
SHREWSBURY MA
01545-4201
US

V. Phone/Fax

Practice location:
  • Phone: 508-792-1903
  • Fax:
Mailing address:
  • Phone: 508-792-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number72632
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: