Provider Demographics
NPI:1497770689
Name:MEHTA, SANDIP G (DO)
Entity Type:Individual
Prefix:
First Name:SANDIP
Middle Name:G
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 405
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6607
Mailing Address - Country:US
Mailing Address - Phone:817-595-4949
Mailing Address - Fax:
Practice Address - Street 1:1305 AIRPORT FWY STE 405
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6607
Practice Address - Country:US
Practice Address - Phone:817-595-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160500801Medicaid
TX160500802Medicaid
TX160500801Medicaid
TX8L8711Medicare PIN
TX8L2513Medicare PIN
TXH90034Medicare UPIN