Provider Demographics
NPI:1265659965
Name:MEHTA, MALTI PRAFUL (MD)
Entity Type:Individual
Prefix:
First Name:MALTI
Middle Name:PRAFUL
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1040 X RAY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5438
Mailing Address - Country:US
Mailing Address - Phone:704-867-9601
Mailing Address - Fax:704-868-3939
Practice Address - Street 1:459 N WENDOVER RD
Practice Address - Street 2:MALTI AND P MEHTA PA
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-364-9171
Practice Address - Fax:704-364-0176
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC240172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958498Medicaid
NCC85497Medicare UPIN
NC8958498Medicaid