TENNISON LEWIS MALCOLM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****32

License Status

ACTIVE

Business

Title

First Name

TENNISON

Middle

LEWIS

Last Name

MALCOLM

Business Name

TENNISON LEWIS MALCOLM MD

Original Issue Date

06/04/2021

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

BOSTON

State

Zip

02115

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023