Provider Demographics
NPI:1902865843
Name:MALDONADO, MELVIN HIPOLITO (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:HIPOLITO
Last Name:MALDONADO
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:PO BOX 193239
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3239
Mailing Address - Country:US
Mailing Address - Phone:787-781-8316
Mailing Address - Fax:787-783-0432
Practice Address - Street 1:1028 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2904
Practice Address - Country:US
Practice Address - Phone:787-781-8316
Practice Address - Fax:787-783-0432
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020292Medicare ID - Type Unspecified
PRH82801Medicare UPIN