Provider Demographics
NPI:1164734448
Name:MEHTA, PRATIK ARUNKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:ARUNKUMAR
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 1:502 SIXTH BAXTER XING
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6428
Mailing Address - Country:US
Mailing Address - Phone:803-835-2088
Mailing Address - Fax:803-835-2099
Practice Address - Street 1:502 SIXTH BAXTER XING
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6428
Practice Address - Country:US
Practice Address - Phone:803-835-2088
Practice Address - Fax:803-835-2099
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC361959Medicaid
SC361959Medicaid