Provider Demographics
NPI:1275539421
Name:KANTSIPER, MELINDA ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:ELLEN
Last Name:KANTSIPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELINDA
Other - Middle Name:ELLEN
Other - Last Name:BARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5755 CEDAR LN
Mailing Address - Street 2:HOWARD COUNTY GENERAL HOSPITAL -CIMS
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2912
Mailing Address - Country:US
Mailing Address - Phone:410-884-4644
Mailing Address - Fax:410-884-4643
Practice Address - Street 1:5755 CEDAR LN
Practice Address - Street 2:HOWARD COUNTY GENERAL HOSPITAL -CIMS
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2912
Practice Address - Country:US
Practice Address - Phone:410-884-4644
Practice Address - Fax:410-884-4643
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S732-F292Medicare ID - Type Unspecified
H31392Medicare UPIN