Individual
AYESHA MALLICK IMAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 MEDICAL CENTER DR, SPRINGFIELD, OH 45504-2687
(937) 523-4147
Mailing address
150 BERGEN STREET,, SUITE E-401, NEWARK,, NJ 07101-1709
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35.144361
OH
Other
Enumeration date
04/24/2013
Last updated
11/02/2022
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