MEDICARE: SANJAY RASIK MEHTA DO

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	207R00000X	Internal Medicine Physician	254	WV
2	207R00000X	Internal Medicine Physician	0102202805	VA

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	:	1518969138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY RASIK MEHTA DO

Provider Business Mailing Address
First Line	:	340 PEPPERS FERRY RD
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-2091
Country	:	US
Telephone Number	:	276-250-1675
Fax Number	:	206-203-0141

Provider Business Practice Location Address
First Line	:	340 PEPPERS FERRY RD
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-2091
Country	:	US
Telephone Number	:	276-250-1675
Fax Number	:	206-203-0141

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/07/2015

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Directions to “ SANJAY RASIK MEHTA DO” Practice Location

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