Basic Information
| Provider Information | |||||||||
| NPI: | 1154522167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | PALAK | ||||||||
| MiddleName: | PRANAV | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1002 | ||||||||
| Address2: | |||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175221002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177214740 | ||||||||
| FaxNumber: | 7177386872 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 MARTIN AVE | ||||||||
| Address2: | |||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177214740 | ||||||||
| FaxNumber: | 7177386872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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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 | 207RG0300X | 25MA08608800 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208M00000X | MD443391 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RG0300X | MD443391 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.