Provider Demographics
NPI:1568691145
Name:MEHTA, PRANAV DILIP (MBCHB, MD)
Entity Type:Individual
Prefix:MR
First Name:PRANAV
Middle Name:DILIP
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MBCHB, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740B STENTON AVE
Mailing Address - Street 2:APARTMENT 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3169
Mailing Address - Country:US
Mailing Address - Phone:216-543-5701
Mailing Address - Fax:
Practice Address - Street 1:7740B STENTON AVE
Practice Address - Street 2:APARTMENT 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3169
Practice Address - Country:US
Practice Address - Phone:216-543-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA196152390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA196152OtherPA MEDICAL BOARD