Provider Demographics
NPI:1710937875
Name:MEHTA, MAHENDRA P (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:P
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5911 KILLARNEY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2349
Mailing Address - Country:US
Mailing Address - Phone:408-528-7246
Mailing Address - Fax:408-528-7246
Practice Address - Street 1:2919 THE VILLAGES PKWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1442
Practice Address - Country:US
Practice Address - Phone:408-274-2244
Practice Address - Fax:408-528-7246
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC51516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79491Medicare UPIN
MIA79491Medicare ID - Type Unspecified