Healthcare Provider Details

I. General information

NPI: 1932170933
Provider Name (Legal Business Name): JYOTI J MEHTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST
WILLIAMSBURG OH
45176-1146
US

IV. Provider business mailing address

PO BOX 643113
CINCINNATI OH
45264-3113
US

V. Phone/Fax

Practice location:
  • Phone: 513-724-2226
  • Fax: 513-724-5248
Mailing address:
  • Phone: 513-724-2226
  • Fax: 513-345-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35052885M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: