Provider Demographics
NPI:1144420647
Name:BHARGESH P. MEHTA, M.D., P.A.
Entity Type:Organization
Organization Name:BHARGESH P. MEHTA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARGESH
Authorized Official - Middle Name:PRAMODRAY
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-535-5555
Mailing Address - Street 1:1005 PRINCE FREDERICK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3194
Mailing Address - Country:US
Mailing Address - Phone:410-535-5555
Mailing Address - Fax:410-535-5599
Practice Address - Street 1:1005 PRINCE FREDERICK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3194
Practice Address - Country:US
Practice Address - Phone:410-535-5555
Practice Address - Fax:410-535-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045092207R00000X
MDD0046264208000000X
MDD0064682208000000X
MDD0054328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD256000300Medicaid
MD256000300Medicaid