Provider Demographics
NPI:1508808189
Name:CHEITLIN, MELVIN DONALD (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:DONALD
Last Name:CHEITLIN
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 7464
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7464
Mailing Address - Country:US
Mailing Address - Phone:415-206-3103
Mailing Address - Fax:415-206-3872
Practice Address - Street 1:1001 PORTRERO AVE
Practice Address - Street 2:RM 5G1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-3503
Practice Address - Fax:415-206-5100
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC66174207R00000X
CAC33174207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C331740Medicaid
CA060022124OtherRAILROAD MEDICARE
CA00C331741Medicare ID - Type Unspecified
CA00C331740Medicaid