Provider Demographics
NPI:1770636821
Name:MELMAN, KENNETH NEWPORT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NEWPORT
Last Name:MELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:HOWARD
Other - Last Name:MELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-467-6300
Mailing Address - Fax:206-467-6301
Practice Address - Street 1:805 MADISON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1172
Practice Address - Country:US
Practice Address - Phone:206-467-6300
Practice Address - Fax:206-467-6301
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000186922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1011295Medicaid
WA1011295Medicaid
WAA06080Medicare UPIN