Provider Demographics
NPI:1619932282
Name:MEHTA, AVANISH (MD)
Entity Type:Individual
Prefix:DR
First Name:AVANISH
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2138 MENDON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3834
Mailing Address - Country:US
Mailing Address - Phone:401-333-8500
Mailing Address - Fax:401-333-5711
Practice Address - Street 1:2138 MENDON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3834
Practice Address - Country:US
Practice Address - Phone:401-333-8500
Practice Address - Fax:401-333-5711
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD09719207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI06-1480182OtherTUFTS
RI0402103OtherUNITED HEALTH
RI06-1480182OtherNEIGHBORHOOD
RI2096336OtherAETNA
RI5184338OtherENVOY
RI9002716Medicaid
RIHPAA7135OtherHARVARD PILGRIM
RI0474256OtherCIGNA
RI2716-4OtherBLUE CROSS
RI403003OtherBLUECHIP
RIHPAA7135OtherHARVARD PILGRIM
RI2716-4OtherBLUE CROSS