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General NPI Number Information
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NPI Number | 1265401962
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Entity Type | Individual
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Provider Name | HASUMATI VIJAYKUMAR MEHTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 518 SANDHURST DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4426
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Country | US
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Telephone | 910-323-4091
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Fax | 910-323-4092
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Provider Business Mailing Address
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Address Line | PO BOX 87169
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-7169
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Country | US
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Telephone | 910-323-4091
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Fax | 910-323-4092
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20167
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License Number State | NC
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