Provider Demographics
NPI:1659372225
Name:MALHOTRA, ROHIT (MD)
Entity Type:Individual
Prefix:
First Name:ROHIT
Middle Name:
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 1:501 W VAN BUREN ST STE T
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1307
Mailing Address - Country:US
Mailing Address - Phone:623-932-9905
Mailing Address - Fax:623-386-6555
Practice Address - Street 1:501 W VAN BUREN ST STE T
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1307
Practice Address - Country:US
Practice Address - Phone:623-932-9905
Practice Address - Fax:623-932-6901
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894099Medicaid
AZ894099Medicaid
AZ1000097Medicare ID - Type UnspecifiedMARICOPA
AZ1000098Medicare ID - Type UnspecifiedPINAL COUNTY