Provider Demographics
NPI:1447546403
Name:BHALLA, MALAVIKA (MD)
Entity type:Individual
Prefix:DR
First Name:MALAVIKA
Middle Name:
Last Name:BHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MALAVIKA
Other - Middle Name:
Other - Last Name:BANDARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3201E
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-2724
Mailing Address - Fax:
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3201E
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2749812085R0202X
CT0542592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology