Provider Demographics
NPI:1790004950
Name:MALHOTRA, SIDDHARTH VED (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDDHARTH
Middle Name:VED
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 1:108 ENDO LN
Mailing Address - Street 2:STE 3
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-4567
Mailing Address - Country:US
Mailing Address - Phone:910-205-7775
Mailing Address - Fax:910-205-7790
Practice Address - Street 1:108 ENDO LN
Practice Address - Street 2:SUITE 3
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4566
Practice Address - Country:US
Practice Address - Phone:910-205-7775
Practice Address - Fax:910-205-7775
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104089208600000X
NC2015-00930174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCN919AMedicare PIN