Provider Demographics
NPI:1699724294
Name:MALHOTRA, AMIT (MD)
Entity type:Individual
Prefix:DR
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 1:8060 WOLF RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1727
Mailing Address - Country:US
Mailing Address - Phone:901-271-1000
Mailing Address - Fax:901-271-4187
Practice Address - Street 1:391 SOUTHCREST CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6730
Practice Address - Country:US
Practice Address - Phone:901-271-1000
Practice Address - Fax:901-271-4187
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36555207RC0000X
MS19492207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
06120013401OtherQUALCHOICE
TN000379332OtherRAIL ROAD MEDICARE
TN4146200OtherBCBS
TN7019599OtherAETNA
AR84389OtherBCBS
MSP00372262OtherRAIL ROAD MEDICARE
MS03907881Medicaid
TN27550OtherTLC
TN3892297Medicaid
06120013401OtherQUALCHOICE
TN27550OtherTLC
MS302I066585Medicare PIN