=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346241569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL F MELVILLE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2005
-----------------------------------------------------
Last Update Date | 01/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 545 A CENTRE ST BETH ISRAEL DEACONESS HEALTH CARE - JAMAICA PLAIN
-----------------------------------------------------
City | JAMAICA PLAIN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02130-2071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-522-5464
-----------------------------------------------------
Fax | 617-524-2966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 545 A CENTRE ST BETH ISRAEL DEACONESS HEALTH CARE - JAMAICA PLAIN
-----------------------------------------------------
City | JAMAICA PLAIN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02130-2071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-522-5464
-----------------------------------------------------
Fax | 617-524-2966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 80675
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------