Provider Demographics
NPI:1740249598
Name:MEHTA, ANITA (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2225 EAST W T HARRIS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213
Mailing Address - Country:US
Mailing Address - Phone:704-509-0933
Mailing Address - Fax:704-509-0934
Practice Address - Street 1:2225 EAST W T HARRIS BLVD
Practice Address - Street 2:STE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213
Practice Address - Country:US
Practice Address - Phone:704-509-0933
Practice Address - Fax:704-509-0934
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9601002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958579Medicaid
G34459Medicare UPIN