Provider Demographics
NPI:1679523609
Name:GOLDIN, MELVIN LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:LESTER
Last Name:GOLDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6401 POPLAR AVENUE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4840
Mailing Address - Country:US
Mailing Address - Phone:901-683-0030
Mailing Address - Fax:901-683-9522
Practice Address - Street 1:6401 POPLAR AVENUE
Practice Address - Street 2:SUITE 318
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4840
Practice Address - Country:US
Practice Address - Phone:901-683-0030
Practice Address - Fax:901-683-9522
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0103102084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183007Medicaid
TN3183007Medicaid
TNB04053Medicare UPIN