Healthcare Provider Details

I. General information

NPI: 1245388701
Provider Name (Legal Business Name): CRAIG MALCOLM PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 STATE HIGHWAY, ROUTE 6 UNIT 2
WELLFLEET MA
02667
US

IV. Provider business mailing address

PO BOX 2796
ORLEANS MA
02653-6796
US

V. Phone/Fax

Practice location:
  • Phone: 508-905-2434
  • Fax: 508-905-2855
Mailing address:
  • Phone: 508-432-1400
  • Fax: 508-487-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6731
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: