Healthcare Provider Details

I. General information

NPI: 1639162084
Provider Name (Legal Business Name): RITU MALHOTRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 LAKE AVE
ASHTABULA OH
44004-4985
US

IV. Provider business mailing address

PO BOX 567
CHAGRIN FALLS OH
44022-0567
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-6943
  • Fax: 440-997-6513
Mailing address:
  • Phone: 246-464-5160
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35063834
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: