Provider Demographics
NPI:1578850194
Name:ELCHICO, MELANIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:C
Last Name:ELCHICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:C
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-543-2218
Practice Address - Fax:619-471-6473
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1247262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology