Healthcare Provider Details

I. General information

NPI: 1275761504
Provider Name (Legal Business Name): SHARYN MALCOLM M.D./ M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW CHILDREN'S NATIONAL MEDICAL CENTER,
WASHINGTON DC
20010
US

IV. Provider business mailing address

111 MICHIGAN AVE NW CHILDREN'S NATIONAL MEDICAL CENTER,
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD040612
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD040612
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: