Provider Demographics
NPI:1568816999
Name:MALIK, KIRAN (MD)
Entity type:Individual
Prefix:MS
First Name:KIRAN
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 GODWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8274
Mailing Address - Country:US
Mailing Address - Phone:757-935-5310
Mailing Address - Fax:757-935-5311
Practice Address - Street 1:3060 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8274
Practice Address - Country:US
Practice Address - Phone:757-935-5310
Practice Address - Fax:757-935-5311
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2019-06-04
Deactivation Date:2016-12-06
Deactivation Code:
Reactivation Date:2017-01-05
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101264974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program