Provider Demographics
NPI:1326131921
Name:MALCOLM, JAMES A III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:MALCOLM
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PORTER
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-6326
Mailing Address - Fax:802-388-4904
Practice Address - Street 1:116 PORTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8501
Practice Address - Country:US
Practice Address - Phone:802-388-6326
Practice Address - Fax:802-388-4904
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420004424207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00004601Medicaid
VTE97172Medicare UPIN
VT00004601Medicaid