Basic Information
| Provider Information | |||||||||
| NPI: | 1013972470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL-MEHTA | ||||||||
| FirstName: | VINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67670 TRACO DR | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439509375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307584515 | ||||||||
| FaxNumber: | 3307585121 | ||||||||
| Practice Location | |||||||||
| Address1: | 67670 TRACO DR | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439509375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307584515 | ||||||||
| FaxNumber: | 3307585121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35071909M | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0116584000 | 05 | WV | MEDICAID | 2231392 | 05 | OH | MEDICAID |