Provider Demographics
NPI:1801848957
Name:MEHRA, VIKRAM (MD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:MEHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21613 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6506
Mailing Address - Country:US
Mailing Address - Phone:713-777-9900
Mailing Address - Fax:713-777-9902
Practice Address - Street 1:21613 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6506
Practice Address - Country:US
Practice Address - Phone:713-777-9900
Practice Address - Fax:713-777-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ65912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00476TOtherMEDICARE GROUP
TX116322205Medicaid
TXG05444Medicare UPIN
TX00476TOtherMEDICARE GROUP