Healthcare Provider Details

I. General information

NPI: 1861485591
Provider Name (Legal Business Name): JEET RAM MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COLONIAL DR
YOUNGSTOWN OH
44505-2137
US

IV. Provider business mailing address

16 COLONIAL DR
YOUNGSTOWN OH
44505-2137
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-8545
  • Fax: 330-759-8543
Mailing address:
  • Phone: 330-759-8545
  • Fax: 330-759-8543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35-03-6259-M
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD015942E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: