Provider Demographics
NPI:1760422505
Name:MEHTA, SHOBHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBHA
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 1:1532 PEAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4663
Mailing Address - Country:US
Mailing Address - Phone:215-727-3772
Mailing Address - Fax:215-638-1305
Practice Address - Street 1:5627 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5345
Practice Address - Country:US
Practice Address - Phone:215-727-3772
Practice Address - Fax:215-638-1305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038929L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC33879Medicare UPIN
PA424167Medicare ID - Type Unspecified