Provider Demographics
NPI:1396238192
Name:MEHROTRA, MAYANK (MD)
Entity type:Individual
Prefix:MR
First Name:MAYANK
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1120 15TH STREET AUGUSTA UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912
Mailing Address - Country:US
Mailing Address - Phone:610-570-3480
Mailing Address - Fax:706-446-3546
Practice Address - Street 1:1120 15TH STREET AUGUSTA UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:610-570-3480
Practice Address - Fax:706-446-3546
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2019-01-22
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Provider Licenses
StateLicense IDTaxonomies
GA009947207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology