Provider Demographics
NPI:1407993868
Name:MEHTA, NUPUR (MD)
Entity Type:Individual
Prefix:DR
First Name:NUPUR
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NUPUR
Other - Middle Name:PRAFUL
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:143 BOARDMAN CANFIELD RD STE 359
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4804
Mailing Address - Country:US
Mailing Address - Phone:234-200-0854
Mailing Address - Fax:
Practice Address - Street 1:600 SUPERIOR AVENUE EAST
Practice Address - Street 2:FIFTH/THIRD BUILDING SUITE 1300
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:234-200-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266382207R00000X, 207R00000X
CAC160106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine