Healthcare Provider Details

I. General information

NPI: 1679667059
Provider Name (Legal Business Name): SALMAN S MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MEDICAL PARK BLVD SUITE B
PETERSBURG VA
23805-9289
US

IV. Provider business mailing address

5855 BREMO RD STE 506
RICHMOND VA
23226-1925
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-6730
  • Fax: 804-520-6731
Mailing address:
  • Phone: 804-520-6730
  • Fax: 804-520-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101248043
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: