Basic Information
| Provider Information | |||||||||
| NPI: | 1023428380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALHOTRA | ||||||||
| FirstName: | VESHAL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12470 TELECOM DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137796303 | ||||||||
| FaxNumber: | 8889771998 | ||||||||
| Practice Location | |||||||||
| Address1: | 12470 TELECOM DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137796303 | ||||||||
| FaxNumber: | 8889771998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | OS15411 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | OS15411 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.