Provider Demographics
NPI:1396891834
Name:GASTROENTEROLOGY & HEPATOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:GASTROENTEROLOGY & HEPATOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP
Authorized Official - Phone:703-823-0333
Mailing Address - Street 1:4660 KENMORE AVENUE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-823-0333
Mailing Address - Fax:703-823-8611
Practice Address - Street 1:4660 KENMORE AVENUE
Practice Address - Street 2:SUITE 810
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-823-0333
Practice Address - Fax:703-823-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
721300Medicare ID - Type Unspecified