Healthcare Provider Details

I. General information

NPI: 1114951852
Provider Name (Legal Business Name): CECILIA MARIBEE MACCALLUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 THOMSON DR SUITE 200
LYNCHBURG VA
24501-1118
US

IV. Provider business mailing address

2010 ATHERHOLT RD
LYNCHBURG VA
24501
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5925
  • Fax: 434-200-5929
Mailing address:
  • Phone: 434-200-5047
  • Fax: 434-200-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101239992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: