Provider Demographics
NPI:1366091480
Name:MALIK, MAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:MAHAM
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 1:512 REYNOLDS RD APT M12
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1394
Mailing Address - Country:US
Mailing Address - Phone:951-403-2472
Mailing Address - Fax:
Practice Address - Street 1:111 N WASHINGTON AVE FL 1
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1841
Practice Address - Country:US
Practice Address - Phone:570-591-5153
Practice Address - Fax:570-343-4800
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program