Healthcare Provider Details

I. General information

NPI: 1023034436
Provider Name (Legal Business Name): SHAHID MALIK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3299 WOODBURN RD STE 350
ANNANDALE VA
22003-7321
US

IV. Provider business mailing address

PO BOX 1718
HERNDON VA
20172-1718
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-0086
  • Fax: 703-620-6628
Mailing address:
  • Phone: 703-573-0086
  • Fax: 703-620-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101236201
License Number StateVA

VIII. Authorized Official

Name: SHAHID MALIK
Title or Position: PRESIDENT
Credential: MD
Phone: 703-573-0086