Provider Demographics
NPI:1033307905
Name:MARK MELDEN, DO
Entity Type:Organization
Organization Name:MARK MELDEN, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-435-5400
Mailing Address - Street 1:158 C AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1420
Mailing Address - Country:US
Mailing Address - Phone:619-435-5400
Mailing Address - Fax:619-435-5401
Practice Address - Street 1:158 C AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1420
Practice Address - Country:US
Practice Address - Phone:619-435-5400
Practice Address - Fax:619-435-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A79002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX79000Medicaid
CA20A7900AMedicare PIN
CA00AX79000Medicaid
CAH78267Medicare UPIN