Provider Demographics
NPI:1023292596
Name:MALHOTRA, SANJAY (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
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 1:600 SUN TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8643
Mailing Address - Country:US
Mailing Address - Phone:256-288-3333
Mailing Address - Fax:256-288-3334
Practice Address - Street 1:1111 WAYNE RD NW
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3567
Practice Address - Country:US
Practice Address - Phone:256-288-3333
Practice Address - Fax:256-288-3334
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.293752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
661895OtherVALUE OPTIONS
AL1023292596Medicaid
TN2502066OtherBCBS-TN
TN1526630Medicaid
AL515-98260OtherBLUE CROSS-BLUE SHIELD OF AL
TN102I266280Medicare PIN
661895OtherVALUE OPTIONS