Provider Demographics
NPI:1760432108
Name:MELANCON, JOSEPH KEITH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KEITH
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 1:2131 K ST NW STE 800
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1888
Mailing Address - Country:US
Mailing Address - Phone:202-715-4225
Mailing Address - Fax:
Practice Address - Street 1:2131 K ST NW STE 800
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1888
Practice Address - Country:US
Practice Address - Phone:202-715-4225
Practice Address - Fax:202-715-4663
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270515204F00000X, 208600000X
MDD62233204F00000X
DCMD037319204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03687809Medicaid
DCP00894808OtherRAILROAD MEDICARE
MD405991300Medicaid
MDKR72JHMedicare ID - Type UnspecifiedGROUP
MD405991300Medicaid
DCP00894808OtherRAILROAD MEDICARE
MDJ990Medicare ID - Type UnspecifiedINDIVIDUAL
DC175402ZBRPMedicare PIN
NYJ400098594Medicare PIN