Healthcare Provider Details

I. General information

NPI: 1255892196
Provider Name (Legal Business Name): EBAAD MALICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FREDERICK RD
CATONSVILLE MD
21228-4516
US

IV. Provider business mailing address

PO BOX 791775
BALTIMORE MD
21279-1775
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-1880
  • Fax: 410-646-3623
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberD0098698
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: