Provider Demographics
NPI:1114985520
Name:MALIK, JAVAID A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVAID
Middle Name:A
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:403-537-9007
Practice Address - Street 1:1711 27TH ST STE 103
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2670
Practice Address - Country:US
Practice Address - Phone:740-356-6740
Practice Address - Fax:740-355-9281
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271685207L00000X, 207QA0401X, 208VP0014X
OH35.120658207L00000X, 208VP0014X
PAMD423112207QA0401X
PAMD 423112207LC0200X
OH35120658208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011409110004Medicaid
NY03530458Medicaid
PA1011409110003Medicaid