Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 18701 | WV |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 35-06-7511 | OH |
NPI | 1033157367 |
---|---|
Provider Name | Shailen K. Mehta |
First Address | Gallipolis, OH 45631-1560 |
Second Address | Gallipolis, OH 45631-1560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 06/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000007362 | ANTHEM BCBS (01) | |
000000185212 | UNISON MEDICAID (01) | OH |
001714069 | MOUNTAIN STATE BCBS (01) | |
0113594000 | (05) | WV |
0995115 | MOLINA MEDICAID (01) | OH |
250005225 | RR MEDICARE (01) | |
310917085142 | CARESOURCE MEDICAID (01) | OH |
F94190 | (02) |