Provider Demographics
NPI:1568717650
Name:MCCAULEY, MELANIE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DIANE
Last Name:MCCAULEY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:9500 GILMAN DRIVE
Mailing Address - Street 2:MC 0711
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0711
Mailing Address - Country:US
Mailing Address - Phone:858-822-4898
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5601
Practice Address - Fax:601-984-6665
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2016-08-23
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Provider Licenses
StateLicense IDTaxonomies
CAA137371207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST-2571OtherTEMPORARY STATE MEDICAL LICENSE