Provider Demographics
NPI:1336129840
Name:MALIK, TANVEER A (MD)
Entity Type:Individual
Prefix:DR
First Name:TANVEER
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 1:6504 KENILWORTH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1386
Mailing Address - Country:US
Mailing Address - Phone:301-927-8011
Mailing Address - Fax:301-699-1584
Practice Address - Street 1:6504 KENILWORTH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1386
Practice Address - Country:US
Practice Address - Phone:301-927-8011
Practice Address - Fax:301-699-1584
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075570207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4645792Medicaid
MD415845800Medicaid
MI4645792Medicaid
DC511696Medicare PIN
MIH18191Medicare UPIN
MD966LMedicare PIN