Provider Demographics
NPI:1295187060
Name:PAMELA MEHTA MD INC
Entity Type:Organization
Organization Name:PAMELA MEHTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-871-5520
Mailing Address - Street 1:1060 WILLOW ST
Mailing Address - Street 2:SUITE 3-110
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2350
Mailing Address - Country:US
Mailing Address - Phone:415-871-5520
Mailing Address - Fax:
Practice Address - Street 1:2242 CAMDEN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2029
Practice Address - Country:US
Practice Address - Phone:415-871-5520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty