Provider Demographics
NPI:1427151513
Name:ENGEL, MELVIN HAROLD (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:HAROLD
Last Name:ENGEL
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 1:50 GREEN CLIFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357
Mailing Address - Country:US
Mailing Address - Phone:860-739-7194
Mailing Address - Fax:860-739-7194
Practice Address - Street 1:50 GREEN CLIFF DRIVE
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357
Practice Address - Country:US
Practice Address - Phone:860-739-7194
Practice Address - Fax:860-739-7194
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001251834Medicaid
CT001251834Medicaid
D77027Medicare UPIN