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NPI Code Detail

MEDICARE: JARED TYLER MELNYCHUK MD

MEDICARE:   JARED TYLER MELNYCHUK  MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2208M00000XHospitalist Physician2026-01652NC

General Provider Information

NPI Number : 1851094379
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED TYLER MELNYCHUK MD
Provider Business Mailing Address
First Line : 1982 MERGANSER RUN DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-7019
Country : US
Telephone Number : 612-203-4531
Fax Number :
Provider Business Practice Location Address
First Line : MEDICAL CENTER BOULEVARD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27157-0001
Country : US
Telephone Number : 336-716-3182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2023
Last Update Date : 06/08/2026

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