Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | M2697 | TX |
N | 111NI0900X | Internist | M2697 | TX |
Y | 207RH0003X | Hematology & Oncology | M2697 | TX |
NPI | 1073572384 |
---|---|
Provider Name | Antra Mahaldar |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177551201 | (05) | TX |
I47050 | (02) |