Provider Demographics
NPI:1407838295
Name:MELKI, SAMIR A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:A
Last Name:MELKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WEBSTER PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7937
Mailing Address - Country:US
Mailing Address - Phone:617-202-2020
Mailing Address - Fax:617-734-3264
Practice Address - Street 1:24 WEBSTER PL
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7937
Practice Address - Country:US
Practice Address - Phone:617-202-2020
Practice Address - Fax:617-734-3264
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156694207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3177793Medicaid
MAJ18727OtherBCBS
MA3177793Medicaid
MAA23422Medicare ID - Type Unspecified