Provider Demographics
NPI:1972572543
Name:MALHOTRA, SHAILAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILAJA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 AMBERDALE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1259
Mailing Address - Country:US
Mailing Address - Phone:804-818-7041
Mailing Address - Fax:804-785-5550
Practice Address - Street 1:13841 HULL STREET RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2056
Practice Address - Country:US
Practice Address - Phone:804-739-1757
Practice Address - Fax:804-739-0321
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972572543Medicaid
VA0101239800Medicaid
C02381OtherMEDICARE GROUP NUMBER
VA021867P46Medicare PIN
C02381OtherMEDICARE GROUP NUMBER
H75981Medicare UPIN
P00787415Medicare PIN