Provider Demographics
NPI:1710998497
Name:MEHTA, MEHUL CHAMPAKLAL (MBBS; MS)
Entity Type:Individual
Prefix:DR
First Name:MEHUL
Middle Name:CHAMPAKLAL
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MBBS; MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5 GRANGER POND WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1973
Mailing Address - Country:US
Mailing Address - Phone:781-910-9445
Mailing Address - Fax:781-863-2088
Practice Address - Street 1:5 GRANGER POND WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1973
Practice Address - Country:US
Practice Address - Phone:781-910-9445
Practice Address - Fax:781-863-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79855207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3130118Medicaid
MAJ30818Medicare ID - Type Unspecified