Healthcare Provider Details

I. General information

NPI: 1962913368
Provider Name (Legal Business Name): EVGENIA MALIK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVGENIA IOUDINA

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 BALLENGER AVE STE 107
ALEXANDRIA VA
22314-6913
US

IV. Provider business mailing address

1920 BALLENGER AVE STE 107
ALEXANDRIA VA
22314-6913
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-4628
  • Fax: 703-810-5452
Mailing address:
  • Phone: 703-214-4628
  • Fax: 703-810-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007754
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: