Healthcare Provider Details

I. General information

NPI: 1194247213
Provider Name (Legal Business Name): GABRIEL MELKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH ST
WATERVILLE ME
04901-4974
US

IV. Provider business mailing address

149 NORTH ST
WATERVILLE ME
04901-4974
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-1000
  • Fax:
Mailing address:
  • Phone: 207-872-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD27612
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: