Provider Demographics
NPI:1255414157
Name:MEHTA, RAJESH M (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:M
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:PO BOX 161328
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-1328
Mailing Address - Country:US
Mailing Address - Phone:512-368-5294
Mailing Address - Fax:512-368-5289
Practice Address - Street 1:9312 BRODIE LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5176
Practice Address - Country:US
Practice Address - Phone:512-368-5294
Practice Address - Fax:512-368-5289
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0270207RG0100X
OH35062919207RG0100X, 207RI0008X
WV16787207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854384Medicaid
OH1396812491OtherVEC NPI
1434905OtherUMWA
TX313917202Medicaid
DF8863OtherRR MEDCR
TX313917201Medicaid
P00401030OtherRR MEDCR
TX267845YKXYMedicare PIN
P00401030OtherRR MEDCR
OH1396812491OtherVEC NPI
1434905OtherUMWA
WV4062525Medicare PIN
OH4062524Medicare PIN
DF8863OtherRR MEDCR