MEDICARE: SALMAN S MALIK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0101248043	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C06778	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1679667059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALMAN S MALIK MD

Provider Business Mailing Address
First Line	:	5855 BREMO RD
Second Line	:	STE 506
City	:	RICHMOND
State	:	VA
Zip	:	23226-1925
Country	:	US
Telephone Number	:	804-520-6730
Fax Number	:	804-520-6731

Provider Business Practice Location Address
First Line	:	40 MEDICAL PARK BLVD
Second Line	:	SUITE B
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9289
Country	:	US
Telephone Number	:	804-520-6730
Fax Number	:	804-520-6731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/10/2016

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Directions to “ SALMAN S MALIK MD” Practice Location

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