Provider Demographics
NPI:1033318589
Name:PRINCE, MELANIE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DENISE
Last Name:PRINCE
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 1:8201 CANTRELL RD
Mailing Address - Street 2:STE 265
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2453
Mailing Address - Country:US
Mailing Address - Phone:501-225-3333
Mailing Address - Fax:501-225-3338
Practice Address - Street 1:8201 CANTRELL RD
Practice Address - Street 2:STE 265
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2453
Practice Address - Country:US
Practice Address - Phone:501-225-3333
Practice Address - Fax:501-225-3338
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN9979208200000X
ARE-75102086S0122X
ARE7510208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR195170001Medicaid