Provider Demographics
NPI:1447248570
Name:MEHTA, PANKAJ G (MD)
Entity type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:G
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3109
Practice Address - Country:US
Practice Address - Phone:570-323-3671
Practice Address - Fax:570-321-0648
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038224L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160054367OtherRR MEDICARE
PA0007584200002Medicaid
PA19810-7573OtherGHP
PW72703OtherFIRST PRIORITY HMO
PAC29646OtherHEALTH AMMERICA
PA0000093059OtherPA BS
PW72703OtherFIRST PRIORITY HMO
PA19810-7573OtherGHP