Provider Demographics
NPI:1932436771
Name:MELAMUD UROLOGY GROUP
Entity Type:Organization
Organization Name:MELAMUD UROLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MELAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-692-1300
Mailing Address - Street 1:1828 EL CAMINO REAL
Mailing Address - Street 2:SUITE 605
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3103
Mailing Address - Country:US
Mailing Address - Phone:650-692-1300
Mailing Address - Fax:650-692-0220
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:SUITE 605
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3103
Practice Address - Country:US
Practice Address - Phone:650-692-1300
Practice Address - Fax:650-692-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84986208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316055106OtherNPI - AITAN MELAMUD
CA1851447965OtherNPI - ORI MELAMUD
CAA27571Medicare UPIN