Provider Demographics
NPI:1396093043
Name:GERARD F. MELANSON M.D., LLC
Entity type:Organization
Organization Name:GERARD F. MELANSON M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:MELANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-435-0122
Mailing Address - Street 1:1016 NORTH BLVD, EAST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5348
Mailing Address - Country:US
Mailing Address - Phone:352-435-0122
Mailing Address - Fax:352-435-0138
Practice Address - Street 1:1016 NORTH BLVD, EAST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5348
Practice Address - Country:US
Practice Address - Phone:352-435-0122
Practice Address - Fax:352-435-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0074063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG59798Medicare UPIN
FL41895AMedicare PIN