Basic Information
| Provider Information | |||||||||
| NPI: | 1609807056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALHOTRA | ||||||||
| FirstName: | MEENAKSHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5351 CHAMPIONSHIP CUP LN | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346090366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525446050 | ||||||||
| FaxNumber: | 3526888822 | ||||||||
| Practice Location | |||||||||
| Address1: | BROOKSVILLE REGIONAL HOSPITAL, DEPT PATHOLOGY | ||||||||
| Address2: | 17240 CORTEZ BLVD. | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346050037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525446050 | ||||||||
| FaxNumber: | 3526888822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 05/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | ME87731 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 270820500 | 05 | FL | MEDICAID |