Provider Demographics
NPI:1154389716
Name:MELZIG, ERIC PERRY (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:PERRY
Last Name:MELZIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 THREE CHOPT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4601
Mailing Address - Country:US
Mailing Address - Phone:804-825-9416
Mailing Address - Fax:804-285-9461
Practice Address - Street 1:8921 THREE CHOPT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4601
Practice Address - Country:US
Practice Address - Phone:804-825-9416
Practice Address - Fax:804-285-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007369981Medicaid
VABO8692Medicare UPIN
VA007369981Medicaid