MEDICARE: PRADIP M 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
1	207L00000X	Anesthesiology Physician	35.123682	OH
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	35.123682	OH
3	208VP0000X	Pain Medicine Physician	35.123682	OH
4	208VP0014X	Interventional Pain Medicine Physician	35.123682	OH
5	207RA0401X	Addiction Medicine (Internal Medicine) Physician	35.123682	OH

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	:	1639151079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRADIP M MEHTA MD

Provider Business Mailing Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/28/2018

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Directions to “ PRADIP M MEHTA MD” Practice Location

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