Provider Demographics
NPI:1497732424
Name:MEHTA, ASHWINKUMAR S (MD)
Entity Type:Individual
Prefix:
First Name:ASHWINKUMAR
Middle Name:S
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASHWIN
Other - Middle Name:S
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3709 W HAMILTION AVE
Mailing Address - Street 2:#5
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4015
Mailing Address - Country:US
Mailing Address - Phone:813-932-4430
Mailing Address - Fax:813-932-4250
Practice Address - Street 1:3709 W HAMILTION AVE
Practice Address - Street 2:#5
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4015
Practice Address - Country:US
Practice Address - Phone:813-932-4430
Practice Address - Fax:813-932-4250
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047762207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045108800Medicaid
D62235Medicare UPIN
30910Medicare ID - Type Unspecified