Provider Demographics
NPI:1740200088
Name:GEORGALAS, MELANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:GEORGALAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CONSTITUTION BLVD S
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4351
Mailing Address - Country:US
Mailing Address - Phone:203-924-7334
Mailing Address - Fax:203-922-0004
Practice Address - Street 1:25 CONSTITUTION BLVD. SO
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1300
Practice Address - Country:US
Practice Address - Phone:203-924-7334
Practice Address - Fax:203-922-0004
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0306312080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine