1023292596 NPI number — DR. SANJAY MALHOTRA M.D.

Table of content: DR. SANJAY MALHOTRA M.D. (NPI 1023292596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023292596 NPI number — DR. SANJAY MALHOTRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALHOTRA
Provider First Name:
SANJAY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023292596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 SUN TEMPLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35758-8643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-288-3333
Provider Business Mailing Address Fax Number:
256-288-3334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 WAYNE RD NW
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35806-3567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-288-3333
Provider Business Practice Location Address Fax Number:
256-288-3334
Provider Enumeration Date:
12/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD.29375 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 661895 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1023292596 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2502066 . This is a "BCBS-TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1526630 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-98260 . This is a "BLUE CROSS-BLUE SHIELD OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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