Provider Demographics
NPI:1821090655
Name:MALHOTRA, RAVINDRA K (MD)
Entity Type:Individual
Prefix:MR
First Name:RAVINDRA
Middle Name:K
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 1:1070 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4104
Mailing Address - Country:US
Mailing Address - Phone:419-522-2031
Mailing Address - Fax:419-522-2308
Practice Address - Street 1:1070 CRICKET LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4104
Practice Address - Country:US
Practice Address - Phone:419-522-2031
Practice Address - Fax:419-522-2308
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069218M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188952Medicaid
OH0188952Medicaid
OH9331121Medicare ID - Type Unspecified