Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 029501 | CT |
NPI | 1144329939 |
---|---|
Provider Name | Anjali Mehta |
First Address | Bridgeport, CT 06606 |
Second Address | Bridgeport, CT 06606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 19/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001295014 | (05) | CT |
E05279 | (02) |