Healthcare Provider Details

I. General information

NPI: 1235064015
Provider Name (Legal Business Name): TATHEER ALI MALIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 OLD COLUMBIA RD STE B215
COLUMBIA MD
21046-1865
US

IV. Provider business mailing address

10015 OLD COLUMBIA RD STE B215
COLUMBIA MD
21046-1865
US

V. Phone/Fax

Practice location:
  • Phone: 443-212-8157
  • Fax: 443-687-8696
Mailing address:
  • Phone: 443-212-8157
  • Fax: 443-687-8696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: