Provider Demographics
NPI:1669573788
Name:MELAMUD, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MELAMUD
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 1:420 MOUNTAIN AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2736
Mailing Address - Country:US
Mailing Address - Phone:908-458-8333
Mailing Address - Fax:908-357-1191
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR FL 6
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4530
Practice Address - Country:US
Practice Address - Phone:703-698-9335
Practice Address - Fax:703-207-0038
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241613207W00000X, 207WX0107X
DCD0065744207W00000X
MDD0065744207WX0107X
DCMD036660207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015406701Medicaid
VA1669573788Medicaid
DC039351700Medicaid
DC039351700Medicaid
DC002938R87Medicare PIN