Provider Demographics
NPI:1629063193
Name:MACPHERSON-SMITH, MALCOLM LUMSDEN CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:LUMSDEN CLARK
Last Name:MACPHERSON-SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2100 STEPPINGSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2517
Mailing Address - Country:US
Mailing Address - Phone:757-424-6726
Mailing Address - Fax:757-424-8207
Practice Address - Street 1:2100 STEPPINGSTONE SQ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2517
Practice Address - Country:US
Practice Address - Phone:757-424-6726
Practice Address - Fax:757-424-8207
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101034116OtherSTATE LICENCE NUMBER
VA56-0605-5Medicaid
VA56-0605-5Medicaid
VA0101034116OtherSTATE LICENCE NUMBER
VA080003403Medicare PIN