Provider Demographics
NPI:1760542674
Name:GITLIN, MELVIN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:CHARLES
Last Name:GITLIN
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 1:1611 NW 12TH AVE
Mailing Address - Street 2:C 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-7177
Mailing Address - Fax:305-585-7124
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:C 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-7177
Practice Address - Fax:305-585-7124
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08960R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925853Medicaid
LA5N827CQ68Medicare PIN
LAB38809Medicare UPIN