Provider Demographics
NPI:1205809464
Name:MALIK, MAQSOOD AHMAD (MD)
Entity type:Individual
Prefix:
First Name:MAQSOOD
Middle Name:AHMAD
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S CLAUDE A LORD BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3637
Mailing Address - Country:US
Mailing Address - Phone:570-622-4209
Mailing Address - Fax:570-622-1386
Practice Address - Street 1:106 S CLAUDE A LORD BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3637
Practice Address - Country:US
Practice Address - Phone:570-622-4209
Practice Address - Fax:570-622-1386
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020363E207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116993900OtherFEDERAL EMPLOYEES COMP
PA50047342OtherCAPITAL BLUE CROSS
PA0000035926OtherBLUE SHIELD
PA0473231OtherUS HEALTHCARE
PA110031029OtherRAILROAD MEDICARE PBA
PA0006505600001Medicaid
PA01160701OtherKEYSTONE
PA0998130OtherKEYSTONE SPECIALIST
PA18452OtherGEISINGER HEALTH PLAN
PA203010OtherFEDERAL BLACK LUNG
PA0006505600001Medicaid
PA110031029OtherRAILROAD MEDICARE PBA