Provider Demographics
NPI:1417943564
Name:MELENDEZ, ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:MELENDEZ
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 1:282 WASHINGTON STREET
Mailing Address - Street 2:PEDIATRIC INTENSIVE CARE UNIT
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-837-5455
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON STREET
Practice Address - Street 2:PEDIATRIC INTENSIVE CARE UNIT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-837-5455
Practice Address - Fax:727-767-4970
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1288182080P0203X, 2080P0204X
CT668762080P0203X
MA2129822080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7514946OtherCIGNA-PAL
MAJ25605OtherBCBS
MA0186244Medicaid
MA1203129OtherUNITED-PBC
MA204942OtherTUFTS
CT66876OtherMEDICAL LICENSE
MA3019208OtherAETNA
MAJ25605OtherBCBS