Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 25MA08608800 | NJ |
Y | 207RG0300X | Geriatric Medicine | MD443391 | PA |
NPI | 1154522167 |
---|---|
Provider Name | Palak Pranav Mehta |
First Address | Ephrata, PA 17522-1002 |
Second Address | Ephrata, PA 17522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 25/03/2019 |