Provider Demographics
NPI:1639164387
Name:MAGOVERN, MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:MAGOVERN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 COX RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6753
Mailing Address - Country:US
Mailing Address - Phone:804-270-0330
Mailing Address - Fax:804-270-1003
Practice Address - Street 1:7575 COLD HARBOR RD
Practice Address - Street 2:BLDG 2, STE 1-B
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1600
Practice Address - Country:US
Practice Address - Phone:804-730-2250
Practice Address - Fax:804-730-0531
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101021241207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07810Medicare UPIN