Healthcare Provider Details

I. General information

NPI: 1245762566
Provider Name (Legal Business Name): KANCHAN MALHOTRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD STE G25
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

981 STATE HIGHWAY 121 SUITE 3150
ALLEN TX
75013
US

V. Phone/Fax

Practice location:
  • Phone: 740-542-4000
  • Fax:
Mailing address:
  • Phone: 972-798-8553
  • Fax: 972-798-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT4421
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberT4421
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35.149507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: