Provider Demographics
NPI:1558589325
Name:MEHTA, ANURAG (MD)
Entity Type:Individual
Prefix:
First Name:ANURAG
Middle Name:
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 1:1500 E 2ND ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1181
Mailing Address - Country:US
Mailing Address - Phone:775-784-1223
Mailing Address - Fax:
Practice Address - Street 1:1500 E 2ND ST
Practice Address - Street 2:SUITE 302
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1181
Practice Address - Country:US
Practice Address - Phone:775-784-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17454207RC0000X
NV12362207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08809071Medicaid
MS08809071Medicaid