Healthcare Provider Details

I. General information

NPI: 1265663124
Provider Name (Legal Business Name): MALICK G ISLAM MD, FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34453 KING STREET ROW STE 2
LEWES DE
19958-4787
US

IV. Provider business mailing address

34453 KING STREET ROW STE 2
LEWES DE
19958-4787
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-7676
  • Fax: 302-644-4876
Mailing address:
  • Phone: 302-644-7676
  • Fax: 302-644-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC1-0011611
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0090447
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC1-0011611
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: