Provider Demographics
NPI:1144616392
Name:DR. ALISON MEHTA DO LLC
Entity Type:Organization
Organization Name:DR. ALISON MEHTA DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-393-7223
Mailing Address - Street 1:112 MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1914
Mailing Address - Country:US
Mailing Address - Phone:508-393-7223
Mailing Address - Fax:508-393-7026
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1914
Practice Address - Country:US
Practice Address - Phone:508-393-7223
Practice Address - Fax:508-393-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236180261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health