Provider Demographics
NPI:1326360967
Name:MALIK, ROSHNI PRABHU (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROSHNI
Middle Name:PRABHU
Last Name:MALIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ROSHNI
Other - Middle Name:RAGHURAM
Other - Last Name:PRABHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 418056
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8056
Mailing Address - Country:US
Mailing Address - Phone:301-552-8130
Mailing Address - Fax:
Practice Address - Street 1:8118 GOOD LUCK RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3574
Practice Address - Country:US
Practice Address - Phone:301-552-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004163363AS0400X
MDC04163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical