Provider Demographics
NPI:1083610349
Name:LIM, MELY C (MD)
Entity Type:Individual
Prefix:
First Name:MELY
Middle Name:C
Last Name:LIM
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 1:8 COURTNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2699
Mailing Address - Country:US
Mailing Address - Phone:304-926-0940
Mailing Address - Fax:304-926-0943
Practice Address - Street 1:8 COURTNEY DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2699
Practice Address - Country:US
Practice Address - Phone:304-926-0940
Practice Address - Fax:304-926-0943
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0052855000Medicaid
WV0682091Medicare PIN
WVE98031Medicare UPIN