Provider Demographics
NPI:1932179108
Name:MELMED, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MELMED
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 1:11006 VEIRS MILL RD
Mailing Address - Street 2:SUITE L15-282
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2582
Mailing Address - Country:US
Mailing Address - Phone:301-933-7827
Mailing Address - Fax:
Practice Address - Street 1:11301 AMHERST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4665
Practice Address - Country:US
Practice Address - Phone:301-933-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406495000Medicaid
MDP00166367Medicare PIN
DCP00261795Medicare PIN
MD221LJ175Medicare PIN
DC014627R04Medicare PIN
MD406495000Medicaid