Provider Demographics
NPI:1417908138
Name:IMAD, MELHEM A (MD)
Entity Type:Individual
Prefix:
First Name:MELHEM
Middle Name:A
Last Name:IMAD
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:PO BOX 11314
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:113 GAINSBOROUGH SQ STE 400
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1714
Practice Address - Country:US
Practice Address - Phone:757-842-4499
Practice Address - Fax:757-842-4490
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71226207RC0200X
TXM0439207R00000X
VA0101241469207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417908138Medicaid
MD036752400Medicaid
VA00X963P05Medicare PIN
MD036752400Medicaid
MD192507Y19Medicare PIN
VA1417908138Medicaid