Provider Demographics
NPI:1679667059
Name:MALIK, SALMAN S (MD)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:S
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:STE 506
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1925
Mailing Address - Country:US
Mailing Address - Phone:804-520-6730
Mailing Address - Fax:804-520-6731
Practice Address - Street 1:40 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9289
Practice Address - Country:US
Practice Address - Phone:804-520-6730
Practice Address - Fax:804-520-6731
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101248043208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96227800Medicaid
VA1679667059Medicaid
VAC06778OtherGROUP PTAN
I26671Medicare UPIN
343526200Medicare ID - Type Unspecified
NM96227800Medicaid