Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 56276 | CT |
NPI | 1083960934 |
---|---|
Provider Name | Ishan Malhotra |
First Address | Bridgeport, CT 06606-4201 |
Second Address | Bridgeport, CT 06606-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 17/03/2018 |