Provider Demographics
NPI:1730120916
Name:MEHTA, PURVI MANISH (PA)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:MANISH
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2053 VALLEYGATE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3688
Mailing Address - Country:US
Mailing Address - Phone:910-323-9222
Mailing Address - Fax:910-221-9220
Practice Address - Street 1:2053 VALLEYGATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-323-9222
Practice Address - Fax:910-221-9220
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant