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NPI Code Detail

MEDICARE: RAJ MEHTA MD

MEDICARE: RAJ MEHTA MD
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
1207R00000XInternal Medicine Physician137744NY

Other Identifiers

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

General Provider Information

NPI Number : 1306868633
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAJ MEHTA MD
Provider Business Mailing Address
First Line : 105 CANAL LANDING BLVD
Second Line : SUITE 1
City : ROCHESTER
State : NY
Zip : 14626-5107
Country : US
Telephone Number : 585-368-4050
Fax Number : 585-723-6705
Provider Business Practice Location Address
First Line : 170 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1227
Country : US
Telephone Number : 585-368-4050
Fax Number : 585-723-6705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 05/03/2017

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