Provider Demographics
NPI:1871723676
Name:MELIKTERMINAS, EDMOND (MD)
Entity type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:MELIKTERMINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S GLENOAKS BLVD
Mailing Address - Street 2:# 1
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1319
Mailing Address - Country:US
Mailing Address - Phone:818-331-7687
Mailing Address - Fax:
Practice Address - Street 1:303 S GLENOAKS BLVD
Practice Address - Street 2:# 1
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1319
Practice Address - Country:US
Practice Address - Phone:818-331-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine