Provider Demographics
NPI:1023111531
Name:MALCOLM, ALYS (MD)
Entity type:Individual
Prefix:
First Name:ALYS
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2093
Mailing Address - Country:US
Mailing Address - Phone:413-582-2900
Mailing Address - Fax:413-923-9322
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2093
Practice Address - Country:US
Practice Address - Phone:413-582-2900
Practice Address - Fax:413-923-9322
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54957207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology