Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25MA09215400 | NJ |
Y | 207X00000X | Orthopaedic Surgeon | MD420022 | PA |
NPI | 1003851817 |
---|---|
Provider Name | Samir Mehta |
First Address | Philadelphia, PA 19104-5545 |
Second Address | Philadelphia, PA 19104-5545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 31/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I59275 | (02) | WA |