Provider Demographics
NPI:1528362746
Name:MALIK, SUMAIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMAIRA
Middle Name:
Last Name:MALIK
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 1:3306 BARKHAM DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4578
Mailing Address - Country:US
Mailing Address - Phone:904-728-0329
Mailing Address - Fax:
Practice Address - Street 1:1101 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-6605
Practice Address - Country:US
Practice Address - Phone:904-728-0329
Practice Address - Fax:804-358-4075
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS798-L207R00000X
VA0101260429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS798-LOtherMS LIMITED MEDICAL LICENSE 798-L
VA0101260429OtherVIRGINIA STATE LICENSE