Healthcare Provider Details

I. General information

NPI: 1386631869
Provider Name (Legal Business Name): ATIF BABAR MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20680 SENECA MEADOWS PKWY SUITE 200
GERMANTOWN MD
20876-7022
US

IV. Provider business mailing address

PO BOX 2348
GERMANTOWN MD
20875-2348
US

V. Phone/Fax

Practice location:
  • Phone: 240-629-3926
  • Fax: 240-629-3927
Mailing address:
  • Phone: 240-629-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD0060663
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101237904
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA84906
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number213-450
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: