Healthcare Provider Details

I. General information

NPI: 1659374700
Provider Name (Legal Business Name): TARUN MEHRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W MARKET ST STE H
BALTIMORE OH
43105-1283
US

IV. Provider business mailing address

1153 E MAIN ST PO BOX 2563
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-862-0660
  • Fax: 740-862-3704
Mailing address:
  • Phone: 740-687-8990
  • Fax: 740-687-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35076309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: