Healthcare Provider Details

I. General information

NPI: 1235110453
Provider Name (Legal Business Name): MELANEY A CALDWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 WATERSIDE RD SUITE 105
PRINCE GEORGE VA
23875-1265
US

IV. Provider business mailing address

2425 BOULEVARD SUITE 6
COLONIAL HEIGHTS VA
23834-2324
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-0002
  • Fax: 804-520-2259
Mailing address:
  • Phone: 804-520-0002
  • Fax: 804-520-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101054172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: