Basic Information
| Provider Information | |||||||||
| NPI: | 1588824031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | DIPALI | ||||||||
| MiddleName: | SANDIP | ||||||||
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| Credential: | AA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 TECHNOLOGY DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288035008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287715222 | ||||||||
| FaxNumber: | 8287715253 | ||||||||
| Practice Location | |||||||||
| Address1: | 1781 METROMEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106096440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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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 | 367H00000X | 100000163 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1000-00163 | 01 | NC | NORTH CAROLINA ANESTHESIOLOGIST ASSISTANT LICENSE | OTHER |