Healthcare Provider Details

I. General information

NPI: 1992784706
Provider Name (Legal Business Name): FIRASAT S MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 CHESTERFIELD AVE SUITE 300
CHARLESTON WV
25304-1066
US

IV. Provider business mailing address

# L-2329
COLUMBUS OH
43260-2329
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-7576
  • Fax: 304-343-3273
Mailing address:
  • Phone: 304-205-8906
  • Fax: 304-345-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14371
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number14371
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: