1528050895 NPI number — DR. FRANK S MELOGRANA M.D.

Table of content: DR. FRANK S MELOGRANA M.D. (NPI 1528050895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528050895 NPI number — DR. FRANK S MELOGRANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELOGRANA
Provider First Name:
FRANK
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528050895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CLYDE MORRIS BLVD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-673-5100
Provider Business Mailing Address Fax Number:
386-673-6014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CLYDE MORRIS BLVD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-5909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-673-5100
Provider Business Practice Location Address Fax Number:
386-673-6014
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD10133 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: ME140736 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: D0020393 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105427 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900131 . This is a "UNITED HEALTHCARE AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4053643 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 432105237 . This is a "BRAVO HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41789302 . This is a "BCBS MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 028049 . This is a "JOHN HOPKINS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 028049 . This is a "PRIORITY PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1263178 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1467388 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: E6VWJ . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 57620008 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00447984 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120598400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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