Provider Demographics
NPI:1003532680
Name:MAHMUD, MALIK
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:MAHMUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 WATERWORKS RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9364
Mailing Address - Country:US
Mailing Address - Phone:859-494-1604
Mailing Address - Fax:
Practice Address - Street 1:285 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2809
Practice Address - Country:US
Practice Address - Phone:781-235-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist