Healthcare Provider Details

I. General information

NPI: 1619900982
Provider Name (Legal Business Name): MUNEEB S MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 THOMAS JOHNSON DRIVE SUITE 202
FREDERICK MD
21702
US

IV. Provider business mailing address

140 THOMAS JOHNSON DR STE 202
FREDERICK MD
21702-4485
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-7788
  • Fax: 301-694-3184
Mailing address:
  • Phone: 301-694-7788
  • Fax: 301-694-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0070470
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD431551
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT193580
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00040872
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: