Provider Demographics
NPI:1801925748
Name:CHAVINSON, MELVIN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:JAY
Last Name:CHAVINSON
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 1:21169 CLAYTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1967
Mailing Address - Country:US
Mailing Address - Phone:216-321-9798
Mailing Address - Fax:440-918-1011
Practice Address - Street 1:7350 PALISADES PKWY
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5302
Practice Address - Country:US
Practice Address - Phone:440-918-1000
Practice Address - Fax:440-918-1029
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350313602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268848Medicaid
OH000000224368OtherANTHEM BLUE CROSS
CH0427873Medicare ID - Type Unspecified
OHA75726Medicare UPIN