Provider Demographics
NPI:1578650610
Name:MACKENZIE, MALCOLM WELLS (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:WELLS
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN STREET
Mailing Address - Street 2:MOUNT AUBURN HOSPITAL
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:603-847-3404
Mailing Address - Fax:617-499-5579
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:603-847-3404
Practice Address - Fax:617-499-5579
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9604207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology