Provider Demographics
NPI:1154310332
Name:MELNICK, AVROHM (MD)
Entity Type:Individual
Prefix:DR
First Name:AVROHM
Middle Name:
Last Name:MELNICK
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 1:2000 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1626
Mailing Address - Country:US
Mailing Address - Phone:617-964-2299
Mailing Address - Fax:617-964-1583
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1626
Practice Address - Country:US
Practice Address - Phone:617-964-2299
Practice Address - Fax:617-964-1583
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40164207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA66902Medicare UPIN