Basic Information
| Provider Information | |||||||||
| NPI: | 1396238192 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MEHROTRA | ||||||||
| FirstName: | MAYANK | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 15TH STREET AUGUSTA UNIVERSITY MEDICAL CENTER | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105703480 | ||||||||
| FaxNumber: | 7064463546 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 15TH STREET AUGUSTA UNIVERSITY MEDICAL CENTER | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105703480 | ||||||||
| FaxNumber: | 7064463546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2018 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 009947 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.