Provider Demographics
NPI:1760419170
Name:MELINCOFF, MARC (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MELINCOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-5519
Mailing Address - Fax:713-704-3086
Practice Address - Street 1:4500 WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5476
Practice Address - Country:US
Practice Address - Phone:713-861-6490
Practice Address - Fax:832-658-5415
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07630200207QA0505X
TXP1671207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038784Medicaid
G12857Medicare UPIN
077586B8AMedicare ID - Type Unspecified