Provider Demographics
NPI:1295744381
Name:MALIK, HUMERA E (MD)
Entity type:Individual
Prefix:DR
First Name:HUMERA
Middle Name:E
Last Name:MALIK
Suffix:
Gender:F
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:PO BOX 5776
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-0776
Mailing Address - Country:US
Mailing Address - Phone:703-740-4577
Mailing Address - Fax:703-448-1257
Practice Address - Street 1:8321 OLD COURTHOUSE RD
Practice Address - Street 2:STE 202
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3817
Practice Address - Country:US
Practice Address - Phone:703-740-4577
Practice Address - Fax:703-448-1257
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226851207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003015500Medicaid
G01818P01Medicare ID - Type Unspecified
H99653Medicare UPIN