Provider Demographics
NPI:1295817096
Name:MELAMED, NORMA
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:
Last Name:MELAMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12810 HILLCREST RD
Mailing Address - Street 2:SUITE B220
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1525
Mailing Address - Country:US
Mailing Address - Phone:972-991-8466
Mailing Address - Fax:
Practice Address - Street 1:12810 HILLCREST RD
Practice Address - Street 2:SUITE B220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1525
Practice Address - Country:US
Practice Address - Phone:972-991-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG39402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126484802Medicaid
TXB24847Medicare UPIN
TX126484802Medicaid