Provider Demographics
NPI:1043265978
Name:MEHRA, MANDEEP RAJINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:RAJINDER
Last Name:MEHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:A-324
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-8534
Mailing Address - Fax:617-264-5265
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:A-324
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-8534
Practice Address - Fax:617-264-5265
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62717207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407074700Medicaid
MD646245-01OtherBLUE CROSS/BLUE SHIELD
DE1043265978Medicaid
TN1411027OtherBLUE CROSS/BLUE SHIELD
DC037128200Medicaid
G08539Medicare UPIN
MDL152Medicare PIN
MDP00217862Medicare PIN