Provider Demographics
NPI:1881744324
Name:MEHTA, MALA BAKSHI (MD)
Entity type:Individual
Prefix:DR
First Name:MALA
Middle Name:BAKSHI
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3310
Practice Address - Country:US
Practice Address - Phone:703-383-5458
Practice Address - Fax:703-383-5519
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-06-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0050953207RR0500X
VA0101229837207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35804Medicare UPIN
008697M92Medicare ID - Type Unspecified