Healthcare Provider Details

I. General information

NPI: 1912188558
Provider Name (Legal Business Name): MELINDA SEBENICK GILMORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA SEBENICK M.D.

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W 58TH ST STE 206
LOS ANGELES CA
90037-3632
US

IV. Provider business mailing address

1044 STATE ST
SCHENECTADY NY
12307-1508
US

V. Phone/Fax

Practice location:
  • Phone: 323-541-1411
  • Fax:
Mailing address:
  • Phone: 518-370-1441
  • Fax: 518-395-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA42561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA42561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: