Basic Information
| Provider Information | |||||||||
| NPI: | 1124188776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELVIN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | STUART | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 75420 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212755420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033836469 | ||||||||
| FaxNumber: | 7033851062 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 TOWN CENTER PKWY | ||||||||
| Address2: | STE 400 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201903219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105202 | ||||||||
| FaxNumber: | 7038105420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 01/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MT185923 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 2010-00751 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 0101258973 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5916625 | 05 | NC | MEDICAID | NC1308 | 05 | SC | MEDICAID |