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General NPI Number Information
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NPI Number | 1578223400
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Entity Type | Individual
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Provider Name | MALCOLM XAVIER JEFFERIES SR.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 4 ROLLING CROSSROADS
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City | CATONSVILLE
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State | MD
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Zip | 21228
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Country | US
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Telephone | 410-869-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 638 FREDERICK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4625
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Country | US
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Telephone | 443-414-9573
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R211193
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License Number State | MD
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