Healthcare Provider Details

I. General information

NPI: 1609070275
Provider Name (Legal Business Name): ADVITYA NONESUPPLIED MALHOTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MEDICAL CENTER BLVD SUITE 1300
WEBSTER TX
77598-4052
US

IV. Provider business mailing address

2706 DRYWOOD CREEK DR
LEAGUE CITY TX
77573-9074
US

V. Phone/Fax

Practice location:
  • Phone: 281-557-2527
  • Fax: 281-557-7203
Mailing address:
  • Phone: 409-761-0740
  • Fax: 281-557-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP2-0029546
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN5214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: