Provider Demographics
NPI:1992713275
Name:MELMED, EDWARD P (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
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 1:7777 FOREST LN STE A210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2532
Mailing Address - Country:US
Mailing Address - Phone:972-566-7755
Mailing Address - Fax:972-566-7979
Practice Address - Street 1:7777 FOREST LN STE A210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2532
Practice Address - Country:US
Practice Address - Phone:972-566-7755
Practice Address - Fax:972-566-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P634Medicare ID - Type Unspecified
TXB24848Medicare UPIN