Individual
CHARLES H MELVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 704-8034
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
004673
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
F-400885
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236338
—
CT
05
—
02837850
—
NY
Enumeration date
12/26/2006
Last updated
06/15/2011
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