Provider Demographics
NPI:1871858340
Name:MEHTA, RAJESH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:KUMAR
Last Name:MEHTA
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 1:300 56TH STREET, S.E.
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2308
Mailing Address - Country:US
Mailing Address - Phone:304-926-1600
Mailing Address - Fax:304-926-1694
Practice Address - Street 1:300 56TH STREET, S.E.
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2308
Practice Address - Country:US
Practice Address - Phone:304-926-1600
Practice Address - Fax:304-926-1694
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV274102084P0800X, 2084P0804X
OH35.1347332084P0800X, 2084P0804X
MO2012017200390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty