Healthcare Provider Details

I. General information

NPI: 1740497601
Provider Name (Legal Business Name): LALARUKH MALIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 MIDDLEBROOK RD STE 114
GERMANTOWN MD
20874-5286
US

IV. Provider business mailing address

12800 MIDDLEBROOK RD STE 114
GERMANTOWN MD
20874-5286
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-1122
  • Fax: 240-686-1124
Mailing address:
  • Phone: 240-686-1122
  • Fax: 240-686-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT4422
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0066741
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0066741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: