Provider Demographics
NPI:1629085782
Name:MEHTA, VIVEK (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
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 1:201 W RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5857
Mailing Address - Country:US
Mailing Address - Phone:214-552-4284
Mailing Address - Fax:888-488-0755
Practice Address - Street 1:201 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5857
Practice Address - Country:US
Practice Address - Phone:214-552-4284
Practice Address - Fax:888-488-0755
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82325207L00000X, 207LP2900X
TXN0271207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTIN PLUS SUFFIX 103OtherTRICARE
TX194677401Medicaid
FL2644649-00Medicaid
TXTIN PLUS SUFFIX 091OtherTRICARE
TX8BC072OtherBCBS OF TEXAS
TX194677401Medicaid
TXTIN PLUS SUFFIX 103OtherTRICARE
29053Medicare PIN