Provider Demographics
NPI:1689147829
Name:DARGE, MELESE S
Entity Type:Individual
Prefix:
First Name:MELESE
Middle Name:S
Last Name:DARGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 FAIRMONT ST NW APT 509
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6931
Mailing Address - Country:US
Mailing Address - Phone:571-274-6444
Mailing Address - Fax:
Practice Address - Street 1:1401 FAIRMONT ST NW APT 509
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6931
Practice Address - Country:US
Practice Address - Phone:571-274-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14212374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide