Provider Demographics
NPI:1619962438
Name:MALIK, MOHAMMAD K (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:K
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 1:419 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-2336
Mailing Address - Country:US
Mailing Address - Phone:724-758-7524
Mailing Address - Fax:724-758-7525
Practice Address - Street 1:419 SPRING AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-2336
Practice Address - Country:US
Practice Address - Phone:724-758-7524
Practice Address - Fax:724-758-7525
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037698L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006222250002Medicaid
PA112238Medicare PIN
PAE73826Medicare UPIN