Provider Demographics
NPI:1356703573
Name:MALIK, SUFYAN MUSTAFA (MD)
Entity type:Individual
Prefix:DR
First Name:SUFYAN
Middle Name:MUSTAFA
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 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-546-6400
Mailing Address - Fax:
Practice Address - Street 1:145 E CARROLL ST # 101102
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5454
Practice Address - Country:US
Practice Address - Phone:410-912-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0087270208M00000X
390200000X
MDD87270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program