Provider Demographics
NPI:1184642498
Name:MEHTA, NIRAJ N (MD)
Entity Type:Individual
Prefix:
First Name:NIRAJ
Middle Name:N
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:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:5656 KELLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-566-5065
Practice Address - Fax:713-566-5045
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7352207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134701508Medicaid
TX8BC556OtherBCBS
TX134701503Medicaid
TX88866FOtherBCBS
TX88866FOtherBCBS
TX8BC556OtherBCBS
TX10061720Medicare PIN
TX8L9308Medicare PIN