MEDICARE: OCTAVIO MELENDEZ 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	207V00000X	Obstetrics & Gynecology Physician	10122	PR
2	207V00000X	Obstetrics & Gynecology Physician	36585	SC
3	207V00000X	Obstetrics & Gynecology Physician	25MA08597600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	210122	OTHER	MEDICAL CARD SYSTEM
2	600533	OTHER	MMM
3	1604287	OTHER	ACCA
4	2062	OTHER	INTERNATIONAL MEDICAL CAR
5	1218	OTHER	AMERICAN HEALTH INC
6	7310178	OTHER	HUMANA
7	7310178	OTHER	HUMANA REFORMA
8	62875	OTHER	CRUZ AZUL
9	7310178	OTHER	HUMANA HEALTH CARE
10	3710122	OTHER	AUTORIDAD DE ACUEDUCTOS

General Provider Information

NPI Number	:	1770656761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OCTAVIO MELENDEZ M.D.

Provider Business Mailing Address
First Line	:	721 OKATIE HWY
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-3963
Country	:	US
Telephone Number	:	843-987-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1264 RIBAUT RD STE 200
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6127
Country	:	US
Telephone Number	:	843-524-2466
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	06/15/2026

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Directions to “ OCTAVIO MELENDEZ M.D.” Practice Location

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