Healthcare Provider Details

I. General information

NPI: 1477695112
Provider Name (Legal Business Name): MRS. SAIRA MALIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

5615 JORDAN BLVD
NEW MARKET MD
21774-6308
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-5580
  • Fax:
Mailing address:
  • Phone: 301-607-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA30234
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: