Provider Demographics
NPI:1083618995
Name:MELAMED, JULIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:
Last Name:MELAMED
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 1:12738 TAR FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2340
Mailing Address - Country:US
Mailing Address - Phone:978-596-6458
Mailing Address - Fax:
Practice Address - Street 1:4257 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2230
Practice Address - Country:US
Practice Address - Phone:813-948-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC05855Medicare ID - Type UnspecifiedMASS MEDICARE NUMBER
NHRE1204Medicare ID - Type UnspecifiedNH MEDICARE NUMBER
B76476Medicare UPIN