Provider Demographics
NPI:1245201482
Name:MEHTA, PRAVIN V CHANDRA (MD FACE)
Entity type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:V CHANDRA
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MARKLEY DR
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1282
Mailing Address - Country:US
Mailing Address - Phone:716-636-8776
Mailing Address - Fax:
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1522
Practice Address - Country:US
Practice Address - Phone:716-285-1396
Practice Address - Fax:716-285-2497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129523207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0004285874OtherAETNA
NY00675934Medicaid
NY70E621OtherEMPIRE
NY98287OtherGHI
NY040426003431OtherFIDELIS
NY00675934Medicaid
NY081053Medicare ID - Type Unspecified