Provider Demographics
NPI:1093827768
Name:MELCUK, EKATERINA (MD)
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:MELCUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 KINDERSLEY
Mailing Address - Street 2:
Mailing Address - City:MT ROYAL
Mailing Address - State:QC
Mailing Address - Zip Code:H3R153
Mailing Address - Country:CA
Mailing Address - Phone:514-369-9999
Mailing Address - Fax:
Practice Address - Street 1:581 KINDERSLEY
Practice Address - Street 2:
Practice Address - City:TOWN OF MT ROYAL
Practice Address - State:QC
Practice Address - Zip Code:H3R153
Practice Address - Country:CA
Practice Address - Phone:514-369-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics