Provider Demographics
NPI:1740497601
Name:MALIK, LALARUKH (MD)
Entity type:Individual
Prefix:
First Name:LALARUKH
Middle Name:
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 1:19735 GERMANTOWN RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1214
Mailing Address - Country:US
Mailing Address - Phone:240-686-1122
Mailing Address - Fax:240-686-1124
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:SUITE 280
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1214
Practice Address - Country:US
Practice Address - Phone:240-686-1122
Practice Address - Fax:240-686-1124
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066741261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA867633OtherMEDICARE GROUP #
PAP00804834OtherRAILROAD MEDICARE
PA25-1716306OtherDEVON
PA50091891OtherCAPITAL BLUECROSS
PAMD439082OtherLICENSE
PA1007307260034OtherMEDICAID GROUP #
MD414346900Medicaid
PA102418840 0002Medicaid
PAMA2146426OtherHIGHMARK BLUESHIELD
PA102418840 0001Medicaid
PA25-1716306OtherINFORMED
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherHEALTHNET/TRICARE
PA1586628OtherGATEWAY
PA25-1716306OtherINTERGROUP
PA25-1716306OtherINTERGROUP
PA867633OtherMEDICARE GROUP #
MD211NMedicare PIN