MEDICARE: BHARGESH PRAMODRAY 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	208000000X	Pediatrics Physician	D0046264	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1020694	OTHER		CIGNA
2	870226	OTHER	MH	ALLIANCE PPO
3	090422	OTHER		AETNA
4	53593501	OTHER	MD	BC/BS OF MARYLAND
5	1201708	OTHER		UNITED HEALTHCARE
6	4379	OTHER		BC/BS BLUE CHOICE

General Provider Information

NPI Number	:	1518906056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHARGESH PRAMODRAY MEHTA M.D.

Provider Business Mailing Address
First Line	:	110 HOSPITAL RD
Second Line	:	SUITE 205
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4019
Country	:	US
Telephone Number	:	410-535-5555
Fax Number	:	410-535-5599

Provider Business Practice Location Address
First Line	:	110 HOSPITAL RD
Second Line	:	SUITE 205
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4019
Country	:	US
Telephone Number	:	410-535-5555
Fax Number	:	410-535-5599

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	04/07/2008

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Directions to “ BHARGESH PRAMODRAY MEHTA M.D.” Practice Location

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