MEDICARE: MELANIE HALVORSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	00019879	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	390004990	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	51040637HAL	OTHER	BCBS OF ALABAMA
6	51033781HAL	OTHER	BCBS OF ALABAMA
7	51033782HAL	OTHER	BCBS OF ALABAMA
8	3110016	OTHER	UNITED HEALTH
9	F49427	OTHER	HEALTH SPRINGS

General Provider Information

NPI Number	:	1265438527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE HALVORSON M.D.

Provider Business Mailing Address
First Line	:	4760 WOODMERE BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3065
Country	:	US
Telephone Number	:	334-288-0814
Fax Number	:	334-288-3417

Provider Business Practice Location Address
First Line	:	4760 WOODMERE BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3065
Country	:	US
Telephone Number	:	334-288-0814
Fax Number	:	334-288-3417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/19/2010

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Directions to “ MELANIE HALVORSON M.D.” Practice Location

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