Provider Demographics
NPI:1164487435
Name:FELICIANO, MELVYN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:ANTHONY
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4411 THE 25 WAY NE STE 150
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF ALBUQUERQUE, P.A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5888
Mailing Address - Country:US
Mailing Address - Phone:505-332-6919
Mailing Address - Fax:505-332-6921
Practice Address - Street 1:4411 THE 25 WAY NE STE 150
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF ALBUQUERQUE, P.A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5888
Practice Address - Country:US
Practice Address - Phone:505-332-6919
Practice Address - Fax:505-332-6921
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1878202085R0202X
NMMD2010-02922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM86431277Medicaid
NMNMAAA2104Medicare PIN
NYG52020Medicare UPIN
NMNMAAA0508Medicare PIN