Provider Demographics
NPI:1609070275
Name:MALHOTRA, ADVITYA NONESUPPLIED (MD)
Entity Type:Individual
Prefix:DR
First Name:ADVITYA
Middle Name:NONESUPPLIED
Last Name:MALHOTRA
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 1:2706 DRYWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-9074
Mailing Address - Country:US
Mailing Address - Phone:409-761-0740
Mailing Address - Fax:281-557-7203
Practice Address - Street 1:1015 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 1300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4052
Practice Address - Country:US
Practice Address - Phone:281-557-2527
Practice Address - Fax:281-557-7203
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP2-0029546207R00000X
TXN5214207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
944711644OtherMYUTMB 944711644-COMMERCIAL NUMBER