Provider Demographics
NPI:1932456019
Name:MELKUS, CAROLYN MCLAUGHLIN (PA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MCLAUGHLIN
Last Name:MELKUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:LEE
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 WILSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 LIGHTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1439
Practice Address - Country:US
Practice Address - Phone:831-649-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant