Provider Demographics
NPI:1740243799
Name:TRIVEDI, MEHUL K (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHUL
Middle Name:K
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-370-9002
Mailing Address - Fax:703-370-2849
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-370-9002
Practice Address - Fax:703-370-2849
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101238651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00255325OtherRR MEDICARE
VAP00255325OtherRR MEDICARE