Provider Demographics
NPI:1710060215
Name:MEHTA, RAJENDRA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:KUMAR
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 39473
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-0473
Mailing Address - Country:US
Mailing Address - Phone:216-520-3022
Mailing Address - Fax:216-520-3023
Practice Address - Street 1:6150 OAK TREE BLVD # 100A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6917
Practice Address - Country:US
Practice Address - Phone:440-743-8145
Practice Address - Fax:216-201-6382
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00130605OtherRAILROAD MEDICARE ID
OH0702421Medicaid
OHME4022557Medicare PIN
OH0702421Medicaid
OHME4022552Medicare PIN
OHCO3360Medicare UPIN