Provider Demographics
NPI:1417917733
Name:DONALDSON, MELVIN SAIER (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:SAIER
Last Name:DONALDSON
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 1:3300 WEBSTER ST
Mailing Address - Street 2:STE 612
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3101
Mailing Address - Country:US
Mailing Address - Phone:510-654-5855
Mailing Address - Fax:510-654-0855
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:STE 612
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3101
Practice Address - Country:US
Practice Address - Phone:510-654-5855
Practice Address - Fax:510-654-0855
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA12220208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A19042Medicare UPIN
CA00A1ZZZ00Medicare ID - Type Unspecified