Provider Demographics
NPI:1962740472
Name:MELKUMOVA, EMILIYA (MD)
Entity type:Individual
Prefix:DR
First Name:EMILIYA
Middle Name:
Last Name:MELKUMOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILIYA
Other - Middle Name:
Other - Last Name:MARTIROSYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 WASHINGTON ST, BOX 314
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-5854
Mailing Address - Fax:617-636-8199
Practice Address - Street 1:800 WASHINGTON ST, BOX 314
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5854
Practice Address - Fax:617-636-8199
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2665852084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology