Provider Demographics
NPI:1255380267
Name:MELTON, BARRY C (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:C
Last Name:MELTON
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 1:1040 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4968
Mailing Address - Country:US
Mailing Address - Phone:203-377-5733
Mailing Address - Fax:203-380-0851
Practice Address - Street 1:1040 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4968
Practice Address - Country:US
Practice Address - Phone:203-377-5733
Practice Address - Fax:203-380-0851
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031666208000000X
CT31666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44845Medicare UPIN