Healthcare Provider Details

I. General information

NPI: 1992708515
Provider Name (Legal Business Name): NIKHIL K. MEHTA MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E ANTIETAM ST
HAGERSTOWN MD
21740-5724
US

IV. Provider business mailing address

10016 CHARTWELL MANOR CT
POTOMAC MD
20854-5441
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-8000
  • Fax:
Mailing address:
  • Phone: 301-469-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2002-0074
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2002-0074
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0062526
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101241098
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2002-0074
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0062526
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101241098
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD0062526
License Number StateMD
# 9
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2002-0074
License Number StateNM
# 10
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101241098
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: