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General NPI Number Information
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NPI Number | 1932628351
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Entity Type | Organization
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Legal Business Name | PCCMED, LLC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-3582
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Fax |
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Provider Business Mailing Address
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Address Line | 7817 CALPURNIA CT
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City | MC LEAN
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State | VA
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Zip | 22102-2701
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Country | US
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Telephone | 785-608-1481
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | OSMAN MALIK
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Credential | MD
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Telephone | 785-608-1481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 0101252082
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0101252082
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License Number State | VA
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