Provider Demographics
NPI:1306829551
Name:THORPE, MELANIE A (PA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:THORPE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6123
Mailing Address - Country:US
Mailing Address - Phone:843-678-9777
Mailing Address - Fax:843-665-2814
Practice Address - Street 1:100 HEALTHY WAY STE 1260
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7918
Practice Address - Country:US
Practice Address - Phone:864-225-3551
Practice Address - Fax:864-328-0328
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00087400OtherRAILROAD MEDICARE
SCP00087400OtherRAILROAD MEDICARE
SCS48147Medicare UPIN