Healthcare Provider Details

I. General information

NPI: 1124507231
Provider Name (Legal Business Name): CARLOS EDWARDO MELENDEZ GARCIA MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 LONGWOOD AVE
BOSTON MA
02115
US

IV. Provider business mailing address

PO BOX 1150
VILLALBA PR
00766
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-0000
  • Fax:
Mailing address:
  • Phone: 787-974-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number1019054
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21857
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: