1548396724 NPI number — MELISSA WHITE D C

Table of content: MELISSA WHITE D C (NPI 1548396724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548396724 NPI number — MELISSA WHITE D C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548396724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 N BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25635-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-583-6335
Provider Business Mailing Address Fax Number:
304-583-6800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25635-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-583-6400
Provider Business Practice Location Address Fax Number:
304-583-6800
Provider Enumeration Date:
02/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  798 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7851553 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2003071000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2203071000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063685 . This is a "WV COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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