Provider Demographics
NPI:1477085231
Name:MALLIK, MONICA (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MALLIK
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 1:824 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:PA
Mailing Address - Zip Code:15202-2706
Mailing Address - Country:US
Mailing Address - Phone:412-766-3232
Mailing Address - Fax:412-766-4320
Practice Address - Street 1:824 CALIFORNIA AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-2706
Practice Address - Country:US
Practice Address - Phone:412-766-3232
Practice Address - Fax:412-766-4320
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD478286207RN0300X
OH35.145740207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492549Medicaid
PA103351880Medicaid