Basic Information
| Provider Information | |||||||||
| NPI: | 1619264959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | ANILA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4511 RHETT LN | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220306140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853140557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 W RED BANK AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080961694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568532055 | ||||||||
| FaxNumber: | 8568482879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2011 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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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 | 207P00000X | 0101255550 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 0101255550 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.