Provider Demographics
NPI:1063866101
Name:LACOMBE, MELISSA (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LACOMBE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2442
Mailing Address - Country:US
Mailing Address - Phone:215-728-2000
Mailing Address - Fax:
Practice Address - Street 1:7600 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-728-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine