Provider Demographics
NPI:1972092880
Name:MEHTA MATHER, PUJA DILIP (MD,MS)
Entity type:Individual
Prefix:DR
First Name:PUJA
Middle Name:DILIP
Last Name:MEHTA MATHER
Suffix:
Gender:F
Credentials:MD,MS
Other - Prefix:DR
Other - First Name:PUJA
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:30 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-1256
Mailing Address - Country:US
Mailing Address - Phone:508-244-1280
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-684-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11265900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics