Provider Demographics
NPI:1558460204
Name:MELVIN, C. KEITH (MD)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:KEITH
Last Name:MELVIN
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 1:3131 HARVEY AVE
Mailing Address - Street 2:STE. 104
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3000
Mailing Address - Country:US
Mailing Address - Phone:513-585-9500
Mailing Address - Fax:513-585-9505
Practice Address - Street 1:3131 HARVEY AVE
Practice Address - Street 2:STE. 104
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-585-9500
Practice Address - Fax:513-585-9505
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-047904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64784853Medicaid
OH0546832Medicaid
OHP00884838OtherMEDICARE RR
OH0546832Medicaid
KY64784853Medicaid