Provider Demographics
NPI:1609955137
Name:MELANCON, ERIC JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOSEPH
Last Name:MELANCON
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 1:1151 MARGUERITE ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1850
Mailing Address - Country:US
Mailing Address - Phone:985-384-7288
Mailing Address - Fax:985-384-7291
Practice Address - Street 1:1151 MARGUERITE ST
Practice Address - Street 2:SUITE 200A
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1850
Practice Address - Country:US
Practice Address - Phone:985-384-7288
Practice Address - Fax:985-384-7291
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA110142409OtherRAILROAD MEDICARE
LA1665860Medicaid
LA110142409OtherRAILROAD MEDICARE
1609955137Medicare PIN
LA$$$$$$$$$0OtherBENEFIT MANAGEMENT
LAG09997Medicare UPIN