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General NPI Number Information
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NPI Number | 1366977647
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Entity Type | Individual
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Provider Name | MITALI MEHTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 171 ASHLEY AVE
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City | CHARLESTON
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State | SC
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Zip | 29425-3838
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Country | US
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Telephone | 706-631-1139
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Fax |
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Provider Business Mailing Address
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Address Line | 2170 ANNIE LAURA LN
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-8800
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Country | US
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Telephone | 706-631-1139
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 86023
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License Number State | GA
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