Provider Demographics
NPI:1972710903
Name:MALCOLM N. MCLEOD MD PA
Entity Type:Organization
Organization Name:MALCOLM N. MCLEOD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-967-9112
Mailing Address - Street 1:901 WILLOW DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7078
Mailing Address - Country:US
Mailing Address - Phone:919-967-9112
Mailing Address - Fax:919-929-6085
Practice Address - Street 1:901 WILLOW DR
Practice Address - Street 2:SUITE 3
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7078
Practice Address - Country:US
Practice Address - Phone:919-967-9112
Practice Address - Fax:919-929-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC14736102L00000X, 2084P0800X
NC147362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81705Medicare UPIN
NC203194Medicare PIN
NCC81705Medicare UPIN