Basic Information
| Provider Information | |||||||||
| NPI: | 1992708515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | NIKHIL | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10016 CHARTWELL MANOR CT | ||||||||
| Address2: | |||||||||
| City: | POTOMAC | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208545441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014690284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 251 E ANTIETAM ST | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217405724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017908000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 01/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 2002-0074 | NM | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | D0062526 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0101241098 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2002-0074 | NM | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | D0062526 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 0101241098 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 207P00000X | 2002-0074 | NM | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 208G00000X | D0062526 | MD | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 2002-0074 | NM | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 0101241098 | VA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 28325371 | 05 | NM | MEDICAID | NM019828 | 01 | NM | BCBS | OTHER |