Provider Demographics
NPI:1184823817
Name:UNDERWOOD, MELISSA D (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:UNDERWOOD
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 1:11611 EBY RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:OH
Mailing Address - Zip Code:44276-9795
Mailing Address - Country:US
Mailing Address - Phone:330-939-0147
Mailing Address - Fax:
Practice Address - Street 1:11611 EBY RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:OH
Practice Address - Zip Code:44276-9795
Practice Address - Country:US
Practice Address - Phone:330-939-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089583207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2788489Medicaid
OH4213443Medicare PIN