MEDICARE: DR. RAGHUNATH MEHTA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	105948	NY
2	2084P0802X	Addiction Psychiatry Physician	105948	NY
3	2084P0805X	Geriatric Psychiatry Physician	105948	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073584868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGHUNATH MEHTA M.D

Provider Business Mailing Address
First Line	:	40 WAYNE LN
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1117
Country	:	US
Telephone Number	:	845-365-3968
Fax Number	:	845-365-3968

Provider Business Practice Location Address
First Line	:	40 WAYNE LN
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1117
Country	:	US
Telephone Number	:	845-365-3968
Fax Number	:	845-365-3968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	04/21/2011

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