Provider Demographics
NPI:1902997430
Name:LONGAKER, MELINDA ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ANN
Last Name:LONGAKER
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 1:1225 CRANE STREET
Mailing Address - Street 2:STE 102
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-323-0276
Mailing Address - Fax:650-323-8540
Practice Address - Street 1:1225 CRANE STREET
Practice Address - Street 2:STE 102
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-323-0276
Practice Address - Fax:650-323-8540
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0G63392207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G63392Medicare ID - Type Unspecified
E81450Medicare UPIN