Provider Demographics
NPI:1326139726
Name:MEHTA, MAHESHKUMAR P (MD)
Entity Type:Individual
Prefix:MR
First Name:MAHESHKUMAR
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 1:1190 N STATE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202
Mailing Address - Country:US
Mailing Address - Phone:601-709-0607
Mailing Address - Fax:601-709-0887
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:STE 300
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202
Practice Address - Country:US
Practice Address - Phone:601-709-0607
Practice Address - Fax:601-709-0887
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13014207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS050017556OtherRAILROAD MEDICARE
MS00012299Medicaid
AL158322Medicaid
MSP00462286OtherRAILROAD MEDICARE
MS512I720001Medicare PIN
MS050017556OtherRAILROAD MEDICARE
MSA14383Medicare UPIN
MS302I057706Medicare PIN