Provider Demographics
NPI:1942209176
Name:MEHTA, SUCHARITA (MD)
Entity type:Individual
Prefix:DR
First Name:SUCHARITA
Middle Name:
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 1:207 MAYFAIR DR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6713
Mailing Address - Country:US
Mailing Address - Phone:718-763-7023
Mailing Address - Fax:718-778-5752
Practice Address - Street 1:207 MAYFAIR DR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6713
Practice Address - Country:US
Practice Address - Phone:718-763-7023
Practice Address - Fax:718-778-5752
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02512572Medicaid
NY02512572Medicaid
NYI02251Medicare UPIN