Provider Demographics
NPI:1891962999
Name:MALIK, BUSHRA I (MD)
Entity Type:Individual
Prefix:
First Name:BUSHRA
Middle Name:I
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3803 W CHESTER PIKE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2336
Mailing Address - Country:US
Mailing Address - Phone:484-337-1530
Mailing Address - Fax:484-337-1412
Practice Address - Street 1:120 VALLEY GREEN LN STE 510
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2080
Practice Address - Country:US
Practice Address - Phone:484-572-6300
Practice Address - Fax:484-572-6305
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4388722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102410421Medicaid
PA171710Medicare PIN