Healthcare Provider Details

I. General information

NPI: 1124220546
Provider Name (Legal Business Name): FAHIM AHMED MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 CALIFORNIA AVE
AVALON PA
15202-2706
US

IV. Provider business mailing address

824 CALIFORNIA AVE
AVALON PA
15202-2706
US

V. Phone/Fax

Practice location:
  • Phone: 412-766-3232
  • Fax: 412-766-1306
Mailing address:
  • Phone: 412-766-3232
  • Fax: 412-766-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD443906
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1155757
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA
# 2
Identifier102647656
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: