Provider Demographics
NPI:1649325283
Name:NEMKOV, MELVIN
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:NEMKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BILLERICA RD
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3604
Mailing Address - Country:US
Mailing Address - Phone:978-250-6100
Mailing Address - Fax:978-250-6470
Practice Address - Street 1:228 BILLERICA RD
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3604
Practice Address - Country:US
Practice Address - Phone:978-250-6100
Practice Address - Fax:978-250-6470
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2043998Medicaid
MAB3915101Medicare PIN