Provider Demographics
NPI:1982822664
Name:LUIS MELGAR PHYSICIAN, PC
Entity Type:Organization
Organization Name:LUIS MELGAR PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-648-7401
Mailing Address - Street 1:5893 CAMP RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4470
Mailing Address - Country:US
Mailing Address - Phone:716-648-7401
Mailing Address - Fax:716-648-7524
Practice Address - Street 1:5893 CAMP RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4470
Practice Address - Country:US
Practice Address - Phone:716-648-7401
Practice Address - Fax:716-648-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190379207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01616348Medicaid
NYRA4777Medicare ID - Type Unspecified