Healthcare Provider Details

I. General information

NPI: 1588978118
Provider Name (Legal Business Name): GAURAV MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44084 RIVERSIDE PARKWAY, SUITE 300
LEESBURG VA
20176-5102
US

IV. Provider business mailing address

224- D CORNWALL STREET, NW, SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-724-7530
  • Fax:
Mailing address:
  • Phone: 703-737-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101285584
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125060123
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0011080
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number0101285584
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: