Healthcare Provider Details

I. General information

NPI: 1154652295
Provider Name (Legal Business Name): DAVID MICHAEL MELAMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID MICHAEL MELAMED M.D.

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date: 01/26/2010
Reactivation Date: 01/28/2010

III. Provider practice location address

203 CALIFORNIA ST NE
ALBUQUERQUE NM
87108-1802
US

IV. Provider business mailing address

5401 LOMAS BLVD NE SUITE B
ALBUQUERQUE NM
87110-6457
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-8296
  • Fax:
Mailing address:
  • Phone: 575-706-8548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD2007-0654
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD2007-0654
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: