Provider Demographics
NPI:1255363339
Name:MALIK, ABDUL (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
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 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:SUITE 403
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-823-6408
Practice Address - Fax:443-279-0537
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD207472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
705BPSOtherBSMD GROUP #
0011OtherBSDC
166155OtherMHN
61206BOtherMAMS
K452OtherBSDC GROUP #
34040003OtherBSMD
67803OtherCIGN GROUP #
028214000OtherMAGE
253621OtherCOMP
252450OtherCOMP GROUP #
001742OtherVAL
226282OtherKAIS GROUP #
PVPB121879OtherAPS
PVPB121879OtherAPS GROUP #
150N132GOtherMEMD
608189300OtherOWCP
67803OtherCIGN
1509543OtherUNHC
226282OtherKAIS
979011003OtherMAMD