1144471152 NPI number — DR. MELISSA TABOR D.O

Table of content: DR. MELISSA TABOR D.O (NPI 1144471152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144471152 NPI number — DR. MELISSA TABOR D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TABOR
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
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:
1144471152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 AUBURN DR
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
216-593-0661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6780 MAYFIELD RD
Provider Second Line Business Practice Location Address:
SUITE #410
Provider Business Practice Location Address City Name:
MAYFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-995-2767
Provider Business Practice Location Address Fax Number:
216-593-0661
Provider Enumeration Date:
10/08/2008

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: 207QS0010X , with the licence number:  34.012546 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QS0010X , with the licence number: OS 10487 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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