Provider Demographics
NPI:1265743447
Name:MALHOTRA, AMIT (MD)
Entity type:Individual
Prefix:
First Name:AMIT
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 1:2722 MERRILEE DR
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4400
Mailing Address - Country:US
Mailing Address - Phone:703-698-4444
Mailing Address - Fax:
Practice Address - Street 1:2300 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8920
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-849-1013
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012751162085R0202X
PAMD4392392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
827319OtherFIRST PRIORITY HEALTH
50099763OtherCAPITAL BLUE CROSS
2592533OtherHIGHMARK BLUE SHIELD
827319OtherFIRST PRIORITY HEALTH