Provider Demographics
NPI:1407860729
Name:MEHTA, MARY BAILEY (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BAILEY
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-505-4700
Practice Address - Fax:850-505-4772
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2019-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME613462080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374774300Medicaid
AL009940595Medicaid
MS03405385Medicaid
FL374774300Medicaid
F76246Medicare UPIN