Provider Demographics
NPI:1730188152
Name:MELKONIAN, SUZY (MD)
Entity type:Individual
Prefix:DR
First Name:SUZY
Middle Name:
Last Name:MELKONIAN
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 1:10028 LUBAO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3517
Mailing Address - Country:US
Mailing Address - Phone:818-727-0205
Mailing Address - Fax:
Practice Address - Street 1:10028 LUBAO AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3517
Practice Address - Country:US
Practice Address - Phone:818-727-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83152207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134420201Medicaid
CA1134420201Medicaid
CA0163770002Medicare NSC
CAWG83152AMedicare ID - Type Unspecified