Provider Demographics
NPI:1508056474
Name:MELMAN, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:MELMAN
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 1:575 MAIN STREET 2ND FLOOR
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:
Practice Address - Street 1:5 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3372
Practice Address - Country:US
Practice Address - Phone:860-253-9024
Practice Address - Fax:860-253-9593
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD181602084P0800X
CT0443562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236338Medicaid
CT001443563Medicaid
CT071850Medicare PIN
CT004236338Medicaid
CT260004767(C00814)Medicare PIN
CT260004767 (C00814)Medicare PIN