Healthcare Provider Details

I. General information

NPI: 1619962438
Provider Name (Legal Business Name): MOHAMMAD K MALIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 SPRING AVE
ELLWOOD CITY PA
16117-2336
US

IV. Provider business mailing address

419 SPRING AVE
ELLWOOD CITY PA
16117-2336
US

V. Phone/Fax

Practice location:
  • Phone: 724-758-7524
  • Fax: 724-758-7525
Mailing address:
  • Phone: 724-758-7524
  • Fax: 724-758-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD037698L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: