Provider Demographics
NPI:1740329507
Name:SHAHAB A MALIK MD, LLC.
Entity type:Organization
Organization Name:SHAHAB A MALIK MD, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:ASGHAR
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-582-9630
Mailing Address - Street 1:1403 MADISON PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6292
Mailing Address - Country:US
Mailing Address - Phone:410-582-9630
Mailing Address - Fax:410-582-9653
Practice Address - Street 1:1403 MADISON PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6292
Practice Address - Country:US
Practice Address - Phone:410-582-9630
Practice Address - Fax:410-582-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD698105400Medicaid