Basic Information
| Provider Information | |||||||||
| NPI: | 1851689673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | SAMAR | ||||||||
| MiddleName: | BHARAT | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1730 BANK ST APT 7 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212312448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132999924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 S GREENE ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103288667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 274534 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RC0200X | AU4176435-M999110988 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | 274534 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 274534 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 390200000X | 274534 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.