Provider Demographics
NPI:1285694752
Name:RAJEEV MEHTA MD INC
Entity type:Organization
Organization Name:RAJEEV MEHTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-866-3336
Mailing Address - Street 1:415 BYERS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3696
Mailing Address - Country:US
Mailing Address - Phone:937-866-3336
Mailing Address - Fax:937-865-0122
Practice Address - Street 1:415 BYERS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3684
Practice Address - Country:US
Practice Address - Phone:937-866-3336
Practice Address - Fax:937-865-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060106M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237710Medicaid
OH=========OtherANTHEM
OH=========OtherUNITED HEALTHCARE
OH0237710Medicaid
OH0237710Medicaid
OHE73635Medicare UPIN
OH9284113Medicare ID - Type Unspecified
OH9284111Medicare ID - Type Unspecified