Individual
DR. BRIAN JAMES MELVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(800) 720-1664
Mailing address
301 E MAIN ST, BAY SHORE, NY 11706-8408
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
280025-1
NY
207R00000X
Internal Medicine Physician
237230
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168922160
DRIVER LICENSE
CT
Enumeration date
06/30/2008
Last updated
09/13/2016
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