1902854128 NPI number — MRS. MELISSA A DOVE PA-C

Table of content: MRS. MELISSA A DOVE PA-C (NPI 1902854128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902854128 NPI number — MRS. MELISSA A DOVE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOVE
Provider First Name:
MELISSA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
MELISSA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902854128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5520 CHEVIOT ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45247-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-451-4033
Provider Business Mailing Address Fax Number:
513-451-4118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5520 CHEVIOT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45247-7069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-451-4033
Provider Business Practice Location Address Fax Number:
513-451-4118
Provider Enumeration Date:
05/04/2006

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: 363A00000X , with the licence number:  50-002071 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 50-00-2071 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9500492500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".