Provider Demographics
NPI:1932170933
Name:MEHTA, JYOTI J (MD)
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:J
Last Name:MEHTA
Suffix:
Gender:F
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 643113
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3113
Mailing Address - Country:US
Mailing Address - Phone:513-724-2226
Mailing Address - Fax:513-345-6281
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-1146
Practice Address - Country:US
Practice Address - Phone:513-724-2226
Practice Address - Fax:513-724-5248
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052885M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0614473Medicaid
OHA16326Medicare UPIN
OH0578576Medicare PIN