Provider Demographics
NPI:1477072783
Name:MALHOTRA, ANMOL RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANMOL
Middle Name:RAY
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:MALHOTRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5442 KAVENY DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4117
Mailing Address - Country:US
Mailing Address - Phone:408-893-7725
Mailing Address - Fax:
Practice Address - Street 1:2099 GATEWAY PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1093
Practice Address - Country:US
Practice Address - Phone:408-893-7725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD2571280OtherDRIVER'S LICENSE