Provider Demographics
NPI:1427110469
Name:MALHOTRA, RADHIKA
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BANK ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2806
Mailing Address - Country:US
Mailing Address - Phone:203-888-8669
Mailing Address - Fax:203-888-6302
Practice Address - Street 1:100 BANK ST
Practice Address - Street 2:SUITE 307
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2806
Practice Address - Country:US
Practice Address - Phone:203-888-8669
Practice Address - Fax:203-888-6302
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0339182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT220953OtherPREFERRED ONE
CT5769633OtherAETNA US HEALTHCARE
CTP998690OtherOXFORD
CT01003918CT02OtherANTHEM BCBS
CT0227800004OtherCIGNA
CT2V2885OtherHEALTH NET
CT12-02623OtherUNITED HEALTH CARE
CT033918OtherCONNECTICARE