Provider Demographics
NPI:1174840516
Name:GROVES, MELISSA ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELAINE
Last Name:GROVES
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:PO BOX 5036
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-5036
Mailing Address - Country:US
Mailing Address - Phone:914-964-7862
Mailing Address - Fax:845-765-9396
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3402
Practice Address - Country:US
Practice Address - Phone:914-964-7862
Practice Address - Fax:845-765-9396
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD77675207V00000X
MDD0077675207V00000X
DC390200000X
MD390200000X
NY292854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422962200Medicaid
MDG00121Medicare UPIN
MD367278ZAEMedicare PIN