Provider Demographics
NPI:1265663124
Name:ISLAM, MALICK G (MD, FACC)
Entity Type:Individual
Prefix:
First Name:MALICK
Middle Name:G
Last Name:ISLAM
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34453 KING STREET ROW
Mailing Address - Street 2:STE 2
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4787
Mailing Address - Country:US
Mailing Address - Phone:302-644-7676
Mailing Address - Fax:302-644-4876
Practice Address - Street 1:34453 KING STREET ROW
Practice Address - Street 2:STE 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4787
Practice Address - Country:US
Practice Address - Phone:302-644-7676
Practice Address - Fax:302-644-4876
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0011611207RC0001X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program