Healthcare Provider Details

I. General information

NPI: 1295232353
Provider Name (Legal Business Name): KEVIN RICHARD MELNICK II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S MAIN ST
FALL RIVER MA
02724-2107
US

IV. Provider business mailing address

200 MILL RD
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-0004
  • Fax: 508-678-6970
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number1016087
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: