Provider Demographics
NPI:1194722447
Name:MEHTA, DILIP A (MD)
Entity type:Individual
Prefix:
First Name:DILIP
Middle Name:A
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 GULF DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4020
Mailing Address - Country:US
Mailing Address - Phone:727-841-8212
Mailing Address - Fax:727-841-9589
Practice Address - Street 1:5626 GULF DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4020
Practice Address - Country:US
Practice Address - Phone:727-841-8212
Practice Address - Fax:727-841-9589
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00582552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370403300Medicaid
FL370403300Medicaid
FL11403Medicare ID - Type Unspecified