Provider Demographics
NPI:1205883774
Name:MEHROTRA, VINIT (MD)
Entity type:Individual
Prefix:
First Name:VINIT
Middle Name:
Last Name:MEHROTRA
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 1:713 GRAINGER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3261
Mailing Address - Country:US
Mailing Address - Phone:817-336-3968
Mailing Address - Fax:817-336-7817
Practice Address - Street 1:713 GRAINGER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3261
Practice Address - Country:US
Practice Address - Phone:817-336-3968
Practice Address - Fax:817-336-7817
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM33212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182518401Medicaid
TX8F3735Medicare PIN
TXI61536Medicare UPIN