Provider Demographics
NPI:1609612191
Name:MELVIN, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MELVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 S DAKOTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3024
Mailing Address - Country:US
Mailing Address - Phone:917-692-8261
Mailing Address - Fax:
Practice Address - Street 1:3528 S DAKOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3024
Practice Address - Country:US
Practice Address - Phone:917-692-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant