MEDICARE: SHOBHA H 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	207V00000X	Obstetrics & Gynecology Physician	4301074752	MI
2	207VM0101X	Maternal & Fetal Medicine Physician	MD457036	PA
3	207VM0101X	Maternal & Fetal Medicine Physician	4301074752	MI
4	207VM0101X	Maternal & Fetal Medicine Physician	0101273218	VA
5	207VM0101X	Maternal & Fetal Medicine Physician	2014-02192	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	700H262210	OTHER	BLUE CROSS-BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	SM074752	OTHER	COMMERCIAL-COMMERCIAL NUMBER
5	SM074752	OTHER	CHAMPUS-CHAMPUS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215982020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOBHA H MEHTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 601372
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1372
Country	:	US
Telephone Number	:	704-355-3149
Fax Number	:	704-355-5891

Provider Business Practice Location Address
First Line	:	1025 MOREHEAD MEDICAL PLAZA
Second Line	:	5TH FLOOR, SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2968
Country	:	US
Telephone Number	:	704-355-3149
Fax Number	:	704-355-5891

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/30/2022

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Directions to “ SHOBHA H MEHTA M.D.” Practice Location

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