Provider Demographics
NPI:1780772731
Name:MALHOTRA, SURENDER (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:SURENDER
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FAIRVIEW PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2547
Mailing Address - Country:US
Mailing Address - Phone:478-246-2264
Mailing Address - Fax:478-277-2996
Practice Address - Street 1:202 FAIRVIEW PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2547
Practice Address - Country:US
Practice Address - Phone:478-246-2264
Practice Address - Fax:478-277-2996
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044011207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2021089488Medicare PIN
GAG57821Medicare UPIN
GAG57821Medicare UPIN