Provider Demographics
NPI:1164718045
Name:MALIK, AHSAN FAYYAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AHSAN
Middle Name:FAYYAZ
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 1:20 OLD RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3012
Mailing Address - Country:US
Mailing Address - Phone:203-762-5588
Mailing Address - Fax:203-762-2301
Practice Address - Street 1:20 OLD RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3012
Practice Address - Country:US
Practice Address - Phone:203-762-5588
Practice Address - Fax:203-762-2301
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine