Provider Demographics
NPI:1073989323
Name:JALOTA, ABHIJAY
Entity Type:Individual
Prefix:
First Name:ABHIJAY
Middle Name:
Last Name:JALOTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 HIGH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-6300
Mailing Address - Country:US
Mailing Address - Phone:270-874-2107
Mailing Address - Fax:270-874-2108
Practice Address - Street 1:1717 HIGH ST FL 2
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6300
Practice Address - Country:US
Practice Address - Phone:270-874-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53323207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty