Healthcare Provider Details

I. General information

NPI: 1235399015
Provider Name (Legal Business Name): ALLEN MELVIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 06/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 SPRINGBANK LN SUITE 302
CHARLOTTE NC
28226-3197
US

IV. Provider business mailing address

3315 SPRINGBANK LN SUITE 302
CHARLOTTE NC
28226-3197
US

V. Phone/Fax

Practice location:
  • Phone: 704-540-5566
  • Fax: 704-540-5564
Mailing address:
  • Phone: 704-540-5566
  • Fax: 704-540-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number31951
License Number StateNC

VIII. Authorized Official

Name: JEAN ALLEN MELVIN
Title or Position: OWNER
Credential: M.D.
Phone: 704-540-5566