Provider Demographics
NPI:1861504136
Name:VINIT MEHROTRA, MD, PA
Entity Type:Organization
Organization Name:VINIT MEHROTRA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VINIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHROTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-336-1181
Mailing Address - Street 1:1650 W ROSEDALE
Mailing Address - Street 2:# 301
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:817-336-1181
Mailing Address - Fax:817-336-7817
Practice Address - Street 1:1650 W ROSEDALE
Practice Address - Street 2:# 301
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-336-1181
Practice Address - Fax:817-336-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W904Medicare PIN
TXI61536Medicare UPIN