Provider Demographics
NPI:1376783894
Name:MELCHIODE, GERALD ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ANTHONY
Last Name:MELCHIODE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6820 LEYTONSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1242
Mailing Address - Country:US
Mailing Address - Phone:214-288-3220
Mailing Address - Fax:248-432-7361
Practice Address - Street 1:6820 LEYTONSTONE BLVD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1242
Practice Address - Country:US
Practice Address - Phone:214-288-3220
Practice Address - Fax:248-432-7361
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF78432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry