Provider Demographics
NPI:1316055106
Name:MELAMUD, AITAN (MD)
Entity type:Individual
Prefix:
First Name:AITAN
Middle Name:
Last Name:MELAMUD
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 1:1828 EL CAMINO REAL
Mailing Address - Street 2:#605
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3120
Mailing Address - Country:US
Mailing Address - Phone:650-692-1300
Mailing Address - Fax:650-692-0220
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:#605
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3120
Practice Address - Country:US
Practice Address - Phone:650-692-1300
Practice Address - Fax:650-692-0220
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34763208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0709990001Medicare NSC
00A347630Medicare PIN
A27571Medicare UPIN