1740369032 NPI number — CHRISTOPHER JOSEPH MELCHIORRE PT

Table of content: CHRISTOPHER JOSEPH MELCHIORRE PT (NPI 1740369032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740369032 NPI number — CHRISTOPHER JOSEPH MELCHIORRE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELCHIORRE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1740369032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
463 TIMBER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRASONVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21638-1263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-822-4613
Provider Business Mailing Address Fax Number:
410-822-6534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 S TALBOT ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ST MICHAELS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21663-2637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-822-4613
Provider Business Practice Location Address Fax Number:
410-822-6534
Provider Enumeration Date:
11/06/2006

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: 225100000X , with the licence number:  17171 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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