Basic Information
Provider Information | |||||||||
NPI: | 1760432108 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MELANCON | ||||||||
FirstName: | JOSEPH | ||||||||
MiddleName: | KEITH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2131 K ST NW STE 800 | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200371888 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2027154225 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2131 K ST NW STE 800 | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200371888 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2027154225 | ||||||||
FaxNumber: | 2027154663 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/10/2006 | ||||||||
LastUpdateDate: | 02/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 270515 | NY | N |   | Allopathic & Osteopathic Physicians | Transplant Surgery |   | 204F00000X | D62233 | MD | N |   | Allopathic & Osteopathic Physicians | Transplant Surgery |   | 208600000X | 270515 | NY | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 204F00000X | MD037319 | DC | Y |   | Allopathic & Osteopathic Physicians | Transplant Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 03687809 | 05 | NY |   | MEDICAID | P00894808 | 01 | DC | RAILROAD MEDICARE | OTHER | 405991300 | 05 | MD |   | MEDICAID |