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General NPI Number Information
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NPI Number | 1144420647
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Entity Type | Organization
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Legal Business Name | BHARGESH P. MEHTA, M.D., P.A.
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 1005 PRINCE FREDERICK BLVD SUITE 101
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-3194
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Country | US
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Telephone | 410-535-5555
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Fax | 410-535-5599
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Provider Business Mailing Address
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Address Line | 1005 PRINCE FREDERICK BLVD SUITE 101
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-3194
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Country | US
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Telephone | 410-535-5555
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Fax | 410-535-5599
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. BHARGESH PRAMODRAY MEHTA
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Credential | M.D.
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Telephone | 410-535-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0045092
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0064682
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0054328
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0046264
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License Number State | MD
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