Healthcare Provider Details

I. General information

NPI: 1982904009
Provider Name (Legal Business Name): ROBERT M MELNIKOFF M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 04/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR 4B
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

2500 HOSPITAL DR 4B
MOUNTAIN VIEW CA
94040-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-988-6900
  • Fax:
Mailing address:
  • Phone: 650-988-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA19015
License Number StateCA

VIII. Authorized Official

Name: KAREN L FOX
Title or Position: BUS MANAGER
Credential:
Phone: 650-988-6900