Provider Demographics
NPI:1932579927
Name:SMITH, MALCOLM (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 MEDICAL CENTER DR
Mailing Address - Street 2:RM 5-W414, MSC 9737
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:240-276-6087
Mailing Address - Fax:
Practice Address - Street 1:9609 MEDICAL CENTER DR
Practice Address - Street 2:RM 5-W414, MSC 9737
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:240-276-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-040763-E2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology