Provider Demographics
NPI:1841756368
Name:DELTA NEURODIAGNOSTIC INC
Entity Type:Organization
Organization Name:DELTA NEURODIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KOMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-889-7470
Mailing Address - Street 1:14099 PATTERSON FARM CT
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-9768
Mailing Address - Country:US
Mailing Address - Phone:443-889-7470
Mailing Address - Fax:301-604-7005
Practice Address - Street 1:14099 PATTERSON FARM CT
Practice Address - Street 2:
Practice Address - City:GLENELG
Practice Address - State:MD
Practice Address - Zip Code:21737-9768
Practice Address - Country:US
Practice Address - Phone:443-889-7470
Practice Address - Fax:301-604-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty