Provider Demographics
NPI:1750367595
Name:MEHTA, SUDHA ARUN (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:ARUN
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BURNET AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3098
Mailing Address - Country:US
Mailing Address - Phone:513-357-7289
Mailing Address - Fax:513-357-7307
Practice Address - Street 1:3101 BURNET AVENUE
Practice Address - Street 2:CLEMENT HEALTH CENTER STD CLINIC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3098
Practice Address - Country:US
Practice Address - Phone:513-357-7289
Practice Address - Fax:513-357-7307
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035778207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH616097Medicaid
OH616097Medicaid
C03647Medicare UPIN