MEDICARE: MALIK ALI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	7833572	VA

General Provider Information

NPI Number	:	1649704073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIK ALI

Provider Business Mailing Address
First Line	:	6323 GEORGIA AVE NW STE 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-1137
Country	:	US
Telephone Number	:	202-722-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	6323 GEORGIA AVE NW STE 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-1137
Country	:	US
Telephone Number	:	202-722-1502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	04/12/2017

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Directions to “ MALIK ALI ” Practice Location

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