Provider Demographics
NPI:1801979893
Name:MELKI, TOUFIC S
Entity type:Individual
Prefix:
First Name:TOUFIC
Middle Name:S
Last Name:MELKI
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 1:15020 SHADY GROVE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3379
Mailing Address - Country:US
Mailing Address - Phone:301-279-9123
Mailing Address - Fax:301-279-6828
Practice Address - Street 1:15020 SHADY GROVE RD STE 302
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3379
Practice Address - Country:US
Practice Address - Phone:301-279-9123
Practice Address - Fax:301-279-6828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042835207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01071Medicare UPIN
G01681Medicare PIN