Healthcare Provider Details

I. General information

NPI: 1033125257
Provider Name (Legal Business Name): MARCIA MALCOLM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 W ATLANTIC AVE #401
DELRAY BEACH FL
33484-8174
US

IV. Provider business mailing address

8766 NW 47TH DR
CORAL SPRINGS FL
33067-1950
US

V. Phone/Fax

Practice location:
  • Phone: 561-819-6001
  • Fax: 561-819-6003
Mailing address:
  • Phone: 561-819-6001
  • Fax: 561-819-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMEOO57708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: