Provider Demographics
NPI:1124013313
Name:REIGLE, MELISSA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:REIGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-753-0018
Mailing Address - Fax:440-753-0035
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:SUITE 418
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-753-0018
Practice Address - Fax:440-753-0035
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073524R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG65183Medicare UPIN
OH0843101Medicare ID - Type UnspecifiedMEDICARE NUMBER