Provider Demographics
NPI:1699023200
Name:MEHTA, ADWAIT (MD)
Entity Type:Individual
Prefix:
First Name:ADWAIT
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 1:1133 JOHN FREEMAN BLVD
Mailing Address - Street 2:SUITE JJL S80
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2809
Mailing Address - Country:US
Mailing Address - Phone:713-500-6700
Mailing Address - Fax:713-500-6722
Practice Address - Street 1:5656 KELLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-500-6700
Practice Address - Fax:713-500-6722
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS-0020207R00000X
NMMD2014-1009207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64158357Medicaid