Provider Demographics
NPI:1659354843
Name:MEHTA, RAJAN I (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:I
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 1:737 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5103
Mailing Address - Country:US
Mailing Address - Phone:785-822-0202
Mailing Address - Fax:785-827-6334
Practice Address - Street 1:737 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5103
Practice Address - Country:US
Practice Address - Phone:785-827-7261
Practice Address - Fax:785-833-5709
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038376207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000088459OtherANTHEM
IN351830931100OtherCARESOURCE PIN
IN100184670AMedicaid
IN110051751OtherRAILROAD MCR PIN
IN280784OtherHARMONY PIN
IN351830931OtherTAX ID
IN351830931100OtherCARESOURCE PIN
INE71501Medicare UPIN