Provider Demographics
NPI:1295862134
Name:MEHTA, MANAN S (MD)
Entity type:Individual
Prefix:
First Name:MANAN
Middle Name:S
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHATHAM HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2582
Mailing Address - Country:US
Mailing Address - Phone:540-300-6182
Mailing Address - Fax:540-301-2294
Practice Address - Street 1:405 CHATHAM HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2582
Practice Address - Country:US
Practice Address - Phone:540-300-6182
Practice Address - Fax:540-301-2294
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259771207R00000X, 207RG0100X, 207RH0003X, 207RH0003X
PAMD444656207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05149Medicare PIN
VAC05149Medicare PIN