Provider Demographics
NPI:1154652295
Name:MELAMED, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:MELAMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:MICHAEL
Other - Last Name:MELAMED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5401 LOMAS BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6457
Mailing Address - Country:US
Mailing Address - Phone:575-706-8548
Mailing Address - Fax:
Practice Address - Street 1:5401 LOMAS BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6457
Practice Address - Country:US
Practice Address - Phone:575-706-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-02-03
Deactivation Date:2010-01-26
Deactivation Code:
Reactivation Date:2010-01-28
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0654207N00000X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM300038Medicare PIN
ILE75223Medicare UPIN