Basic Information
| Provider Information | |||||||||
| NPI: | 1285833608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | DIVYANG | ||||||||
| MiddleName: | DOLAT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722340813 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813327505 | ||||||||
| FaxNumber: | 2813327616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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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 | 2085R0001X | N7723 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 12735 | NV | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 218362601 | 05 | TX | MEDICAID | P00790625 | 01 | NV | RAILROAD MEDICARE | OTHER | 218362602 | 05 | TX | MEDICAID | P00889692 | 01 | TX | RAILROAD MEDICARE | OTHER | 1285833608 | 05 | NV | MEDICAID |