Provider Demographics
NPI:1114992468
Name:MEHTA, DARSHAN HEMENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DARSHAN
Middle Name:HEMENDRA
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 TOWER ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3705
Mailing Address - Country:US
Mailing Address - Phone:617-325-1471
Mailing Address - Fax:617-643-6077
Practice Address - Street 1:151 MERRIMAC ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4714
Practice Address - Country:US
Practice Address - Phone:617-643-6046
Practice Address - Fax:617-643-6077
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2105659Medicaid
MAA38761Medicare ID - Type Unspecified
MAI34515Medicare UPIN