1669573788 NPI number — DR. ALEX MELAMUD MD

Table of content: DR. ALEX MELAMUD MD (NPI 1669573788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669573788 NPI number — DR. ALEX MELAMUD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELAMUD
Provider First Name:
ALEX
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669573788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7501 GREENWAY CENTER DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-474-4679
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21351 RIDGETOP CIR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20166-6561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-421-0931
Provider Business Practice Location Address Fax Number:
703-421-7206
Provider Enumeration Date:
09/25/2006

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: 207W00000X , with the licence number:  0101241613 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: D0065744 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: D0065744 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: MD036660 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: 0101241613 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 039351700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669573788 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015406701 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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