MEDICARE: RINA 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	83659	SC
2	208000000X	Pediatrics Physician	2020-02766	NC

General Provider Information

NPI Number	:	1710418033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RINA MEHTA M.D.

Provider Business Mailing Address
First Line	:	51 NASSAU ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5513
Country	:	US
Telephone Number	:	843-722-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 N ELAM AVE STE 202
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1177
Country	:	US
Telephone Number	:	336-299-3183
Fax Number	:	336-299-1762

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	10/11/2022

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