Provider Demographics
NPI:1285782748
Name:MEHTA, NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 224
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:301-774-0074
Mailing Address - Fax:301-774-0640
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 224
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-0074
Practice Address - Fax:301-774-0640
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-04-25
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Provider Licenses
StateLicense IDTaxonomies
MDD0065375207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI73985Medicare UPIN