MEDICARE: MR. RAVINDRA K MALHOTRA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35069218M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821090655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAVINDRA K MALHOTRA M.D

Provider Business Mailing Address
First Line	:	1070 CRICKET LN
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-4104
Country	:	US
Telephone Number	:	419-522-2031
Fax Number	:	419-522-2308

Provider Business Practice Location Address
First Line	:	1070 CRICKET LN
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-4104
Country	:	US
Telephone Number	:	419-522-2031
Fax Number	:	419-522-2308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	01/25/2022

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