Healthcare Provider Details

I. General information

NPI: 1255683181
Provider Name (Legal Business Name): MELIK TIBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 RIVERSIDE DR STE A206
SALISBURY MD
21801-4704
US

IV. Provider business mailing address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-5640
  • Fax: 410-912-5787
Mailing address:
  • Phone: 800-749-5191
  • Fax: 410-630-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number274445
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101262471
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD044268
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD83029
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: