Provider Demographics
NPI:1518906056
Name:MEHTA, BHARGESH PRAMODRAY (MD)
Entity Type:Individual
Prefix:
First Name:BHARGESH
Middle Name:PRAMODRAY
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOSPITAL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4019
Mailing Address - Country:US
Mailing Address - Phone:410-535-5555
Mailing Address - Fax:410-535-5599
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:410-535-5555
Practice Address - Fax:410-535-5599
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046264208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1020694OtherCIGNA
MH870226OtherALLIANCE PPO
090422OtherAETNA
MD53593501OtherBC/BS OF MARYLAND
1201708OtherUNITED HEALTHCARE
4379OtherBC/BS BLUE CHOICE
MD931MJ578Medicare ID - Type Unspecified
MD53593501OtherBC/BS OF MARYLAND