Healthcare Provider Details

I. General information

NPI: 1669471348
Provider Name (Legal Business Name): ASHU P MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 CROFTON BLVD SUITE 101
CROFTON MD
21114-1342
US

IV. Provider business mailing address

PO BOX 37168
BALTIMORE MD
21297-3168
US

V. Phone/Fax

Practice location:
  • Phone: 443-292-4872
  • Fax: 443-292-4892
Mailing address:
  • Phone: 443-292-4872
  • Fax: 443-292-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0060213
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: