Provider Demographics
NPI:1720149784
Name:THORNTON, MELVIN H (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:H
Last Name:THORNTON
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 1:2 CASE CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4942
Mailing Address - Country:US
Mailing Address - Phone:646-737-2470
Mailing Address - Fax:718-253-8117
Practice Address - Street 1:161 MADISON AVE SUITE 4SW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5459
Practice Address - Country:US
Practice Address - Phone:646-737-2470
Practice Address - Fax:718-253-8117
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2177961207VE0102X
NY217796-1207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY217796-1OtherSTATE LICENSE