Basic Information
| Provider Information | |||||||||
| NPI: | 1831479633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALHOTRA | ||||||||
| FirstName: | KONARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 E NORTH AVE STE 206 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598850 | ||||||||
| FaxNumber: | 4123598878 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 E NORTH AVE STE 206 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598850 | ||||||||
| FaxNumber: | 4123598878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 26881 | WV | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | MD467079 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology | 2084N0400X | MD467079 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 13922990 | 01 | CAQH | OTHER | 103650450 | 05 | PA | MEDICAID |