Provider Demographics
NPI:1659310647
Name:MEHTA, KISHOR A (MD)
Entity Type:Individual
Prefix:
First Name:KISHOR
Middle Name:A
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 1:14 BUCKSKIN DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1130
Mailing Address - Country:US
Mailing Address - Phone:781-899-7585
Mailing Address - Fax:
Practice Address - Street 1:14 BUCKSKIN DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1130
Practice Address - Country:US
Practice Address - Phone:781-899-7585
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics