Provider Demographics
NPI:1598919243
Name:MEHTA, NIRAJ H (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:H
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:12309 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1723
Practice Address - Country:US
Practice Address - Phone:954-392-4750
Practice Address - Fax:954-433-1608
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1039832085R0001X, 2085R0001X
FLME 1169592085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL927233OtherWELLCARE
FLP515353Medicaid
FL29496OtherMEDICA
FL927223OtherWELLCARE
FL9129143OtherCIGNA
FLP0020485OtherFLORIDA HEALTHCARE PLUS
FLP1010576OtherFREEDOM HEALTH
FL367687OtherAVMED
FL13451OtherDIMENSIONS HEALTH
FL13451OtherDIMENSION HEALTH
FLP949934OtherOPTIMUM
FL009363800Medicaid
FL14RN2OtherBCBS OF FL
FL367687OtherAVMED
FLP949934OtherOPTIMUM