MEDICARE: DR. JONATHAN MICHAEL MELZER 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Y00000X	Otolaryngology Physician	ME151965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295056273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MICHAEL MELZER M.D.

Provider Business Mailing Address
First Line	:	632 REDGATE AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1702
Country	:	US
Telephone Number	:	703-283-8584
Fax Number	:

Provider Business Practice Location Address
First Line	:	1658 ST VINCENTS WAY STE 200
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-8459
Country	:	US
Telephone Number	:	904-272-3200
Fax Number	:	904-272-3211

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

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	02/03/2023

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Directions to “ DR. JONATHAN MICHAEL MELZER M.D.” Practice Location

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