Provider Demographics
NPI:1710418033
Name:MEHTA, RINA (MD)
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5513
Mailing Address - Country:US
Mailing Address - Phone:843-722-4122
Mailing Address - Fax:
Practice Address - Street 1:510 N ELAM AVE STE 202
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1177
Practice Address - Country:US
Practice Address - Phone:336-299-3183
Practice Address - Fax:336-299-1762
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83659208000000X
NC2020-02766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics