Provider Demographics
NPI:1376651273
Name:WASEEM, MALIKA F (MD)
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:F
Last Name:WASEEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:410-882-3240
Mailing Address - Fax:410-661-5093
Practice Address - Street 1:8800 WALTHER BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234
Practice Address - Country:US
Practice Address - Phone:410-882-3240
Practice Address - Fax:410-661-5093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE314OtherBLUECHOICE #
MD765781100Medicaid
MD110060822OtherRAILROAD MEDICARE #
MD9974MFOtherCAREFIRST MARYLAND #
MDE314OtherBLUECHOICE #
MDF09737Medicare UPIN