Provider Demographics
NPI:1063404325
Name:WILLIS & MELOGRANA MD PC
Entity type:Organization
Organization Name:WILLIS & MELOGRANA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-474-3636
Mailing Address - Street 1:7755 BELLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3316
Mailing Address - Country:US
Mailing Address - Phone:301-474-3636
Mailing Address - Fax:301-513-5087
Practice Address - Street 1:7801 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3337
Practice Address - Country:US
Practice Address - Phone:301-474-3636
Practice Address - Fax:301-513-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD138401500Medicaid
MD138401503Medicaid
DC023375200Medicaid
MD138401502Medicaid
MD138401503Medicaid