Provider Demographics
NPI:1174375059
Name:MEHTA, RAHUL (MS3)
Entity type:Individual
Prefix:
First Name:RAHUL
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MS3
Other - Prefix:MR
Other - First Name:RAHUL
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS3
Mailing Address - Street 1:6975 SILVERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4430
Mailing Address - Country:US
Mailing Address - Phone:847-612-2720
Mailing Address - Fax:
Practice Address - Street 1:4170 CITY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1610
Practice Address - Country:US
Practice Address - Phone:847-612-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program