Provider Demographics
NPI:1982865127
Name:MEHTA, SHIVAN JATIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVAN
Middle Name:JATIN
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 1:423 GUARDIAN DR
Mailing Address - Street 2:BLOCKLEY HALL 1137
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4865
Mailing Address - Country:US
Mailing Address - Phone:215-898-9807
Mailing Address - Fax:
Practice Address - Street 1:423 GUARDIAN DR
Practice Address - Street 2:BLOCKLEY HALL 1137
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4865
Practice Address - Country:US
Practice Address - Phone:215-898-9807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441301207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology