Provider Demographics
NPI:1376702035
Name:MEHTA, KINNER A (MD)
Entity Type:Individual
Prefix:DR
First Name:KINNER
Middle Name:A
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1748
Mailing Address - Country:US
Mailing Address - Phone:607-754-5342
Mailing Address - Fax:607-754-5508
Practice Address - Street 1:1020 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1748
Practice Address - Country:US
Practice Address - Phone:607-754-5342
Practice Address - Fax:607-754-5508
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064603207RG0300X
NY248318207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03045732Medicaid