Provider Demographics
NPI:1629381363
Name:MEHTA, DHARMESH ANANTBHAI (MD)
Entity Type:Individual
Prefix:
First Name:DHARMESH
Middle Name:ANANTBHAI
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6559 WILSON MILLS RD
Mailing Address - Street 2:SUIT 106A
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-6402
Mailing Address - Country:US
Mailing Address - Phone:440-449-1540
Mailing Address - Fax:440-460-2833
Practice Address - Street 1:6559 WILSON MILLS RD
Practice Address - Street 2:SUIT 106A
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-6402
Practice Address - Country:US
Practice Address - Phone:440-449-1540
Practice Address - Fax:440-460-2833
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35121792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program