Provider Demographics
NPI:1871601138
Name:MALIK, QUDSIA IQBAL (MD)
Entity type:Individual
Prefix:
First Name:QUDSIA
Middle Name:IQBAL
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 1:19450 DEERFIELD AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6820
Mailing Address - Country:US
Mailing Address - Phone:703-858-9192
Mailing Address - Fax:703-858-9442
Practice Address - Street 1:19450 DEERFIELD AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-6820
Practice Address - Country:US
Practice Address - Phone:703-858-9192
Practice Address - Fax:703-858-9442
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010133688Medicaid
VAC09324Medicare ID - Type Unspecified
VA010133688Medicaid