Provider Demographics
NPI:1154324341
Name:MELICK, ANN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:ELIZABETH
Last Name:MELICK
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 1:2935 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1487
Mailing Address - Country:US
Mailing Address - Phone:740-454-1216
Mailing Address - Fax:740-454-3830
Practice Address - Street 1:2935 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1487
Practice Address - Country:US
Practice Address - Phone:740-454-1216
Practice Address - Fax:740-454-3830
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068699M207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH800924OtherUHC
OH168474Medicaid
OH3415986091A11OtherBC/BS
OHM68699OtherHPUOV
OHME0787213Medicare ID - Type UnspecifiedMCR
OH168474Medicaid