Provider Demographics
NPI:1053313569
Name:DEGROOT, MELANIE D (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:DEGROOT
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 1:400 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4406
Mailing Address - Country:US
Mailing Address - Phone:281-342-4530
Mailing Address - Fax:281-344-8615
Practice Address - Street 1:400 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4406
Practice Address - Country:US
Practice Address - Phone:281-342-4530
Practice Address - Fax:281-341-2920
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056443L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG20006Medicare UPIN
PA813463Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER