Provider Demographics
NPI:1386882520
Name:MELGAREJO, NICOLAS A (MD)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:A
Last Name:MELGAREJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8042 WURZBACH RD.
Mailing Address - Street 2:#280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3863
Mailing Address - Country:US
Mailing Address - Phone:210-224-9616
Mailing Address - Fax:210-224-5822
Practice Address - Street 1:343 W. HOUSTON ST.
Practice Address - Street 2:SUITE #808
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205
Practice Address - Country:US
Practice Address - Phone:210-224-9616
Practice Address - Fax:210-224-5822
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN1763207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B117780OtherMEDICARE ID#
TX219315301Medicaid