Basic Information
| Provider Information | |||||||||
| NPI: | 1821241530 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PUROHIT | ||||||||
| FirstName: | MAULIK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7703 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103580770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1621 N CEDAR CREST BLVD | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104023300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2008 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 243526 | MA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | Q6978 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P0301X | Q6978 | TX | N | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2081P0301X | MD478626 | PA | Y |
ID Information
| ID | Type | State | Issuer | Description | 375574601 | 05 | TX | MEDICAID | 375574602 | 01 | TX | CSHCN | OTHER |