Healthcare Provider Details

I. General information

NPI: 1093830655
Provider Name (Legal Business Name): TIMOTHY PATRICK MELINSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

5207 27TH ST N
ARLINGTON VA
22207-1746
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax:
Mailing address:
  • Phone: 215-880-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-030567
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: