Healthcare Provider Details

I. General information

NPI: 1093754780
Provider Name (Legal Business Name): SIMON MELNICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 SLADES FERRY AVE
SOMERSET MA
02726-1220
US

IV. Provider business mailing address

67 SLADES FERRY AVE
SOMERSET MA
02726-1220
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-7090
  • Fax:
Mailing address:
  • Phone: 508-675-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number270103
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO00518
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO00518
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: