Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 35.123682 | OH |
Y | 207RA0401X | Internist - Addiction Medicine | 35.123682 | OH |
NPI | 1639151079 |
---|---|
Provider Name | Pradip M Mehta |
First Address | Dayton, OH 45449-5402 |
Second Address | Dayton, OH 45449-5402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 28/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2840804 | (05) | OH |