Provider Demographics
NPI:1023300233
Name:BIRCOLL, MELVYN (MD)
Entity type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:
Last Name:BIRCOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2337 ROSCOMARE RD
Mailing Address - Street 2:# 219
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1854
Mailing Address - Country:US
Mailing Address - Phone:310-471-1550
Mailing Address - Fax:310-471-5970
Practice Address - Street 1:2337 ROSCOMARE RD
Practice Address - Street 2:# 219
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1854
Practice Address - Country:US
Practice Address - Phone:310-471-1550
Practice Address - Fax:310-471-5970
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC-27734208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery