Provider Demographics
NPI:1184863102
Name:MELCHERT, KRISTINA INGRID (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:INGRID
Last Name:MELCHERT
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 1:300 COMMUNITY DRIVE, 3 TOWER
Mailing Address - Street 2:NORTH SHORE UNIVERSITY HOSPITAL, DEPT OF PEDIATRICS
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-562-2542
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DRIVE, 3 TOWER
Practice Address - Street 2:NORTH SHORE UNIVERSITY HOSPITAL, DEPT OF PEDIATRICS
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-14
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 257640208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics