Provider Demographics
NPI:1619264959
Name:MEHTA, ANILA (MD)
Entity Type:Individual
Prefix:
First Name:ANILA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 RHETT LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6140
Mailing Address - Country:US
Mailing Address - Phone:585-314-0557
Mailing Address - Fax:
Practice Address - Street 1:75 W RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1694
Practice Address - Country:US
Practice Address - Phone:856-853-2055
Practice Address - Fax:856-848-2879
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255550207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine