MEDICARE: DR. HOVANNES MELIDONIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A31102	CA

General Provider Information

NPI Number	:	1235271297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOVANNES MELIDONIAN M.D.

Provider Business Mailing Address
First Line	:	318 W COLORADO ST
Second Line	:	#1
City	:	GLENDALE
State	:	CA
Zip	:	91204-1663
Country	:	US
Telephone Number	:	818-548-2618
Fax Number	:	818-548-2618

Provider Business Practice Location Address
First Line	:	318 W COLORADO ST
Second Line	:	#1
City	:	GLENDALE
State	:	CA
Zip	:	91204-1663
Country	:	US
Telephone Number	:	818-548-2618
Fax Number	:	818-548-2618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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