Provider Demographics
NPI:1235238940
Name:MELAMED, BRIAN R (PHD, MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:MELAMED
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-0815
Mailing Address - Country:US
Mailing Address - Phone:888-425-4481
Mailing Address - Fax:302-709-2401
Practice Address - Street 1:169 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1724
Practice Address - Country:US
Practice Address - Phone:717-859-4533
Practice Address - Fax:717-859-4475
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031583E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001043165Medicaid
PA050015081OtherRAILROAD MEDICARE
PA050015081OtherRAILROAD MEDICARE
PAB38267Medicare UPIN