Provider Demographics
NPI:1346266368
Name:MELVIN, MARCUS W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:W
Last Name:MELVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 SW BARNES RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6624
Mailing Address - Country:US
Mailing Address - Phone:503-297-1414
Mailing Address - Fax:503-297-1576
Practice Address - Street 1:9200 SW BARNES RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6624
Practice Address - Country:US
Practice Address - Phone:503-297-1414
Practice Address - Fax:503-297-1576
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD084842086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000BHDHRMedicare ID - Type Unspecified