Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101266293 | VA |
Y | 2080P0202X | Pediatric Cardiologist | 0101266293 | VA |
NPI | 1255687950 |
---|---|
Provider Name | Dr. Keyur Kamlesh Mehta |
First Address | Manassas, VA 20110-4500 |
Second Address | Manassas, VA 20110-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 12/08/2020 |