Provider Demographics
NPI:1881671071
Name:MALATHI V. KOLI M.D
Entity Type:Organization
Organization Name:MALATHI V. KOLI M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALATHI
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAPA
Authorized Official - Phone:210-490-1220
Mailing Address - Street 1:14350 NORTHBROOK DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5030
Mailing Address - Country:US
Mailing Address - Phone:210-490-1220
Mailing Address - Fax:210-490-1260
Practice Address - Street 1:14350 NORTHBROOK DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5030
Practice Address - Country:US
Practice Address - Phone:210-490-1220
Practice Address - Fax:210-490-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG06242084P0800X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No273R00000XHospital UnitsPsychiatric UnitGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A11CMedicare PIN
TXC18007Medicare UPIN