Healthcare Provider Details

I. General information

NPI: 1083841316
Provider Name (Legal Business Name): POOJA MEHTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2009
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 FLATBUSH AVE STE C5
BROOKLYN NY
11225-3706
US

IV. Provider business mailing address

2 LORING ST UNIT C
SOMERVILLE MA
02143-2864
US

V. Phone/Fax

Practice location:
  • Phone: 833-904-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number262866
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: