Healthcare Provider Details

I. General information

NPI: 1184923930
Provider Name (Legal Business Name): NIMESHKUMAR SURESHCHANDRA MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NIMESHKUMAR S MEHTA M.D,

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MISSION ST SE
SALEM OR
97302-6217
US

IV. Provider business mailing address

801 MISSION ST SE
SALEM OR
97302-6217
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-3945
  • Fax: 503-588-0256
Mailing address:
  • Phone: 503-588-3945
  • Fax: 503-689-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD154012
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD154012
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD154012
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: