Provider Demographics
NPI:1750320412
Name:MALIK, ISHTIAQ A (MD)
Entity Type:Individual
Prefix:
First Name:ISHTIAQ
Middle Name:A
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 1:10801 LOCKWOOD DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1556
Mailing Address - Country:US
Mailing Address - Phone:301-592-1780
Mailing Address - Fax:301-592-1783
Practice Address - Street 1:6128 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1016
Practice Address - Country:US
Practice Address - Phone:202-269-7528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-09-12
Deactivation Date:2022-08-18
Deactivation Code:
Reactivation Date:2022-09-12
Provider Licenses
StateLicense IDTaxonomies
DCMD33449207UN0901X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD398660800Medicaid
DC033832300Medicaid
MD398660800Medicaid
DC491198Medicare PIN
DC033832300Medicaid
110240247Medicare PIN
DCP00021285Medicare ID - Type Unspecified