Healthcare Provider Details

I. General information

NPI: 1649666413
Provider Name (Legal Business Name): MALIK HAMDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARPER RD
BECKLEY WV
25801-3397
US

IV. Provider business mailing address

1710 HARPER RD
BECKLEY WV
25801-3397
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-4100
  • Fax: 304-254-3016
Mailing address:
  • Phone: 304-641-7477
  • Fax: 304-254-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28938
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: