Provider Demographics
NPI:1447371281
Name:MEHTA, SHARMILA PRAVIN (MD)
Entity type:Individual
Prefix:
First Name:SHARMILA
Middle Name:PRAVIN
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 BUTTERNUT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4655
Practice Address - Country:US
Practice Address - Phone:864-241-7272
Practice Address - Fax:864-672-7852
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30618207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1447371281Medicaid
SCAA26554746OtherMEDICARE PIN
SC306181Medicaid
SC306181Medicaid
SC0732330001Medicare NSC