Provider Demographics
NPI:1124220546
Name:MALIK, FAHIM AHMED (MD)
Entity Type:Individual
Prefix:
First Name:FAHIM
Middle Name:AHMED
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 1:824 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:PA
Mailing Address - Zip Code:15202-2706
Mailing Address - Country:US
Mailing Address - Phone:412-766-3232
Mailing Address - Fax:412-766-1306
Practice Address - Street 1:824 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:PA
Practice Address - Zip Code:15202-2706
Practice Address - Country:US
Practice Address - Phone:412-766-3232
Practice Address - Fax:412-766-1306
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443906207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1155757OtherCIGNA
PA102647656Medicaid
PA102647656Medicaid