Provider Demographics
NPI:1679654651
Name:MELNICK, JOHN RICHARD (M D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:MELNICK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3266
Mailing Address - Country:US
Mailing Address - Phone:301-258-0944
Mailing Address - Fax:301-258-8804
Practice Address - Street 1:911 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3266
Practice Address - Country:US
Practice Address - Phone:301-258-0944
Practice Address - Fax:301-258-8804
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02717J01Medicare PIN
MDB94110Medicare UPIN