Provider Demographics
NPI:1275712549
Name:MELODIE MORGAN-MINOTT,MD,INC
Entity Type:Organization
Organization Name:MELODIE MORGAN-MINOTT,MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCNHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-673-9111
Mailing Address - Street 1:401 DEVON PL
Mailing Address - Street 2:STE 203
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6482
Mailing Address - Country:US
Mailing Address - Phone:330-673-9111
Mailing Address - Fax:330-673-9730
Practice Address - Street 1:401 DEVON PL
Practice Address - Street 2:STE 203
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6482
Practice Address - Country:US
Practice Address - Phone:330-673-9111
Practice Address - Fax:330-673-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHY01299Medicare UPIN
OH9340501Medicare PIN