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General NPI Number Information
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NPI Number | 1225420722
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Entity Type | Organization
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Legal Business Name | DELRAY PEDIATRICS
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Dates
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Enumeration Date | 02/21/2015
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Last Update Date | 02/21/2015
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Provider Practice Location Address
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Address Line | 4800 LINTON BLVD STE E315 87
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6585
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Country | US
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Telephone | 561-716-7783
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Fax | 561-819-6003
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Provider Business Mailing Address
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Address Line | 4800 LINTON BLVD STE E315 87
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6585
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Country | US
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Telephone | 561-716-7783
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Fax | 561-819-6003
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCIA MARIE MALCOLM
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Credential | M.D.
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Telephone | 561-716-7783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME0057708
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License Number State | FL
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