Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 54957 | MN |
NPI | 1023111531 |
---|---|
Provider Name | Alys Malcolm |
First Address | Northampton, MA 01060-2093 |
Second Address | Northampton, MA 01060-2093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 16/11/2020 |