Provider Demographics
NPI:1215153267
Name:MELAMED, JOEL ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROBERT
Last Name:MELAMED
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:6 PRESTON LANE
Mailing Address - City:TACONIC
Mailing Address - State:CT
Mailing Address - Zip Code:06079-0089
Mailing Address - Country:US
Mailing Address - Phone:860-435-9413
Mailing Address - Fax:860-435-2497
Practice Address - Street 1:1461 SOUTH BRITAIN RD
Practice Address - Street 2:HEALTH CARE UNIT
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-0901
Practice Address - Country:US
Practice Address - Phone:203-586-2000
Practice Address - Fax:203-586-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-03-04
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Provider Licenses
StateLicense IDTaxonomies
CT028594208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE-06450Medicare UPIN