Provider Demographics
NPI:1265438527
Name:HALVORSON, MELANIE (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3065
Mailing Address - Country:US
Mailing Address - Phone:334-288-0814
Mailing Address - Fax:334-288-3417
Practice Address - Street 1:4760 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3065
Practice Address - Country:US
Practice Address - Phone:334-288-0814
Practice Address - Fax:334-288-3417
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019879207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000033781Medicaid
AL000040637Medicaid
390004990OtherRAILROAD MEDICARE
AL000033782Medicaid
51040637HALOtherBCBS OF ALABAMA
51033781HALOtherBCBS OF ALABAMA
51033782HALOtherBCBS OF ALABAMA
3110016OtherUNITED HEALTH
F49427OtherHEALTH SPRINGS
AL000040637Medicaid
AL000033781Medicaid
3110016OtherUNITED HEALTH
000033782HALMedicare ID - Type Unspecified