Provider Demographics
NPI:1326068446
Name:CROSS, MELANIE K (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
Last Name:CROSS
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 4918
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-4918
Mailing Address - Country:US
Mailing Address - Phone:407-581-9180
Mailing Address - Fax:407-926-9173
Practice Address - Street 1:400 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5722
Practice Address - Country:US
Practice Address - Phone:407-581-9180
Practice Address - Fax:407-926-9173
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89809207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2712768 00Medicaid
FL50996OtherBCBS
P00248319OtherRAILROAD MEDICARE
XXX-XX-1727OtherCHAMPUS / TRICARE SOUTH REGION
XXX-XX-1727OtherCHAMPUS / TRICARE SOUTH REGION
P00248319OtherRAILROAD MEDICARE