Provider Demographics
NPI:1720286800
Name:MALIK, HUSSAIN G (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:HUSSAIN
Middle Name:G
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:296 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-424-2830
Mailing Address - Fax:570-424-1793
Practice Address - Street 1:296 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-424-2830
Practice Address - Fax:570-424-1793
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA036586L207Y00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014925280004Medicaid
PA132295Medicare PIN
PAC341184Medicare UPIN