Provider Demographics
NPI:1619900982
Name:MALIK, MUNEEB S (MD)
Entity Type:Individual
Prefix:
First Name:MUNEEB
Middle Name:S
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 1:140 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-694-7788
Mailing Address - Fax:301-694-3184
Practice Address - Street 1:140 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-694-7788
Practice Address - Fax:301-694-3184
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431551207R00000X
WAMD00040872207R00000X
PAMT193580390200000X
MDD0070470207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8310880Medicaid
WAH-59409Medicare UPIN
WAAB28594Medicare ID - Type Unspecified