Provider Demographics
NPI:1740288620
Name:MALIK, MOHAMMAD S (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:S
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-1823
Practice Address - Street 1:8608 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4707
Practice Address - Country:US
Practice Address - Phone:410-922-6900
Practice Address - Fax:410-922-7070
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD26235208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS633 523300OtherCAREFIRST
MD10433662OtherCAQH
MD10433662OtherCAQH