Individual
DR. GREGORY R MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
240 STONERIDGE DR, SUITE 304, COLUMBIA, SC 29210-8013
(803) 708-8126
(803) 708-1370
Mailing address
PO BOX 3387, FREDERICK, MD 21705-3387
(888) 276-1910
(803) 708-1370
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
12464
SC
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
12464
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
12464
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050028871
RR MEDICARE
SC
01
—
124644
SELECT HEALTH
SC
05
—
124644
—
SC
01
—
2001038
CCP
SC
01
—
4130018
AETNA
SC
01
—
77844
MEDCOST
SC
Enumeration date
10/16/2006
Last updated
09/03/2013
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