Healthcare Provider Details

I. General information

NPI: 1346324282
Provider Name (Legal Business Name): BEULAH PUTHUPARAMPIL-MEHTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942A ROUTE 146
CLIFTON PARK NY
12065-3614
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD SUITE 203
LATHAM NY
12110-2442
US

V. Phone/Fax

Practice location:
  • Phone: 518-371-8000
  • Fax: 518-371-5338
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number202386-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: