Provider Demographics
NPI:1386034775
Name:MELVIN, MERLINE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MERLINE
Middle Name:
Last Name:MELVIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 KEEFER PL, N.W.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-288-4026
Mailing Address - Fax:202-882-3572
Practice Address - Street 1:616 KEEFER PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2515
Practice Address - Country:US
Practice Address - Phone:202-288-4026
Practice Address - Fax:202-882-3572
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC5000031171100000X
DC174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator