Provider Demographics
NPI:1497701965
Name:MELGAR, LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MELGAR
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 1:5893 CAMP RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4470
Mailing Address - Country:US
Mailing Address - Phone:716-648-7401
Mailing Address - Fax:716-648-7421
Practice Address - Street 1:5893 CAMP RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4470
Practice Address - Country:US
Practice Address - Phone:716-648-7401
Practice Address - Fax:716-648-7421
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190379207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01616348Medicaid
NY01616348Medicaid
NYRA4777Medicare ID - Type Unspecified