Healthcare Provider Details

I. General information

NPI: 1043343429
Provider Name (Legal Business Name): ANJALI R. MEHTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 300
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST SUITE 300
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3103
  • Fax: 508-368-3104
Mailing address:
  • Phone: 508-368-3103
  • Fax: 508-368-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD12698
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number244036
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: