Provider Demographics
NPI:1215982020
Name:MEHTA, SHOBHA H (MD)
Entity type:Individual
Prefix:
First Name:SHOBHA
Middle Name:H
Last Name:MEHTA
Suffix:
Gender:F
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-355-3149
Mailing Address - Fax:704-355-5891
Practice Address - Street 1:1025 MOREHEAD MEDICAL PLAZA
Practice Address - Street 2:5TH FLOOR, SUITE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2968
Practice Address - Country:US
Practice Address - Phone:704-355-3149
Practice Address - Fax:704-355-5891
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074752207V00000X, 207VM0101X
PAMD457036207VM0101X
VA0101273218207VM0101X
NC2014-02192207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262210OtherBLUE CROSS-BLUE CROSS
NC1215982020Medicaid
MI492502510Medicaid
SM074752OtherCOMMERCIAL-COMMERCIAL NUMBER
SM074752OtherCHAMPUS-CHAMPUS
SCNC2266Medicaid
0H26221144Medicare PIN
700H262210OtherBLUE CROSS-BLUE CROSS
I52992Medicare UPIN
NCNCL509AMedicare PIN