Provider Demographics
NPI:1861485591
Name:MEHTA, JEET RAM (MD)
Entity type:Individual
Prefix:DR
First Name:JEET
Middle Name:RAM
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2137
Mailing Address - Country:US
Mailing Address - Phone:330-759-8545
Mailing Address - Fax:330-759-8543
Practice Address - Street 1:16 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2137
Practice Address - Country:US
Practice Address - Phone:330-759-8545
Practice Address - Fax:330-759-8543
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-6259-M208C00000X
PAMD015942E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1400021OtherUHC
3525578001OtherCIGNA
PACO100187OtherHIGHMARK PA BLUE SHIELD
OH0965835Medicaid
PA3233482OtherSUPERBLUE HMO
OH0356118Medicaid
PA151219OtherKEYSTONE HEALTH PLAN
OH000000129554OtherANTHEM
PA151219OtherKEYSTONE HEALTH PLAN
E33482Medicare UPIN
OHME0414603Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #