=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669573788
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER MELAMUD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8270 WILLOW OAKS CORPORATE DR FL 6
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-698-9335
-----------------------------------------------------
Fax | 703-207-0038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 MOUNTAIN AVE FL 4
-----------------------------------------------------
City | NEW PROVIDENCE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07974-2736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-458-8333
-----------------------------------------------------
Fax | 908-357-1191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 0101241613
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D0065744
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | D0065744
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | MD036660
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | 0101241613
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------