1831192939 NPI number — DR. JOHN WESLEY MELTON III M.D.

Table of content: DR. JOHN WESLEY MELTON III M.D. (NPI 1831192939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192939 NPI number — DR. JOHN WESLEY MELTON III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELTON
Provider First Name:
JOHN
Provider Middle Name:
WESLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831192939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILMARNOCK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22482-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-462-5155
Provider Business Mailing Address Fax Number:
804-462-5922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 LIVELY OAKS RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVELY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-462-5155
Provider Business Practice Location Address Fax Number:
804-462-5922
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  0101018664 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RR0500X , with the licence number: D0015239 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0101018664 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: D0015239 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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