Provider Demographics
NPI:1790843068
Name:MELNICK, GARY N (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:N
Last Name:MELNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:8644 SUDLEY RD STE 305
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-368-1969
Practice Address - Fax:703-369-4164
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD33064207V00000X
DCMD30204207V00000X
VA0101039571207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101039571OtherSTATE LICENSE
005914M92Medicare ID - Type Unspecified