Provider Demographics
NPI:1346239852
Name:ARZADON, MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ARZADON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JAVIER
Other - Last Name:DELOSANGELES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11042 NICHOLAS LN
Mailing Address - Street 2:SUITE B102
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3299
Mailing Address - Country:US
Mailing Address - Phone:443-523-0601
Mailing Address - Fax:410-973-1453
Practice Address - Street 1:11042 NICHOLAS LN
Practice Address - Street 2:UNIT B102
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3299
Practice Address - Country:US
Practice Address - Phone:443-523-0601
Practice Address - Fax:410-973-1453
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD561890800Medicaid
H81761Medicare UPIN
MDKP95F475Medicare PIN