Provider Demographics
NPI:1487208559
Name:MALHAN, SURAJ (DO)
Entity type:Individual
Prefix:
First Name:SURAJ
Middle Name:
Last Name:MALHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WALNUT ST # 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5191
Mailing Address - Country:US
Mailing Address - Phone:215-955-2243
Mailing Address - Fax:
Practice Address - Street 1:900 WALNUT ST # 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5191
Practice Address - Country:US
Practice Address - Phone:215-955-2243
Practice Address - Fax:215-955-2060
Is Sole Proprietor?:No
Enumeration Date:2019-07-28
Last Update Date:2025-05-22
Deactivation Date:2019-10-08
Deactivation Code:
Reactivation Date:2020-04-15
Provider Licenses
StateLicense IDTaxonomies
PAOS0233072084N0400X
390200000X
NJ25MB126378002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program