Provider Demographics
NPI:1285686063
Name:MEHTA, MADHUSUDAN P (MD)
Entity Type:Individual
Prefix:
First Name:MADHUSUDAN
Middle Name:P
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 1:6900 PEARL RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-845-0900
Mailing Address - Fax:440-845-7355
Practice Address - Street 1:6900 PEARL RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-845-0900
Practice Address - Fax:440-845-7355
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039184207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0119571Medicaid
OH0877414Medicare ID - Type Unspecified
OH0119571Medicaid