Provider Demographics
NPI:1033125257
Name:MALCOLM, MARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8766 NW 47TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1950
Mailing Address - Country:US
Mailing Address - Phone:561-819-6001
Mailing Address - Fax:561-819-6003
Practice Address - Street 1:5353 W ATLANTIC AVE
Practice Address - Street 2:#401
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8174
Practice Address - Country:US
Practice Address - Phone:561-819-6001
Practice Address - Fax:561-819-6003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMEOO57708208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF34362Medicare UPIN