Provider Demographics
NPI:1427407295
Name:MEHTA, SANJIV DEVENDRA (MD, MBE)
Entity Type:Individual
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First Name:SANJIV
Middle Name:DEVENDRA
Last Name:MEHTA
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Gender:M
Credentials:MD, MBE
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Other - Last Name:
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Mailing Address - Street 1:3401 CIVIC CENTER BLVD STE 9329
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:267-425-9300
Mailing Address - Fax:267-425-9331
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1858
Practice Address - Fax:215-590-1415
Is Sole Proprietor?:No
Enumeration Date:2016-06-12
Last Update Date:2022-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4678752080P0203X, 2080P0203X
PAMT2104212080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine