Provider Demographics
NPI:1114951852
Name:MACCALLUM, CECILIA MARIBEE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:MARIBEE
Last Name:MACCALLUM
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 1:2010 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-200-5047
Mailing Address - Fax:434-200-6490
Practice Address - Street 1:1701 THOMSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1118
Practice Address - Country:US
Practice Address - Phone:434-200-5925
Practice Address - Fax:434-200-5929
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101239992OtherMEDICAL LICENSE NUMBER
VA010294941Medicaid
VAI61086Medicare UPIN
VA010294941Medicaid