Provider Demographics
NPI:1588721112
Name:MALCOLM, SHARON (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:10701 ROSEMARY DR
Practice Address - Street 2:KAISER PERMANENTE MANASSAS MEDICAL CENTER
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7282
Practice Address - Country:US
Practice Address - Phone:703-257-3000
Practice Address - Fax:703-257-3134
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235554207R00000X
DCMD040039207R00000X
MDD0072311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588721112OtherNPI
VA010026440Medicaid
VA002849F02Medicare ID - Type Unspecified
VA010026440Medicaid