Provider Demographics
NPI:1326488339
Name:MELANIE PRINCE, MD, PA
Entity Type:Organization
Organization Name:MELANIE PRINCE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-993-2927
Mailing Address - Street 1:8201 CANTRELL RD
Mailing Address - Street 2:STE 265
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2453
Mailing Address - Country:US
Mailing Address - Phone:501-225-3333
Mailing Address - Fax:501-225-3338
Practice Address - Street 1:8201 CANTRELL RD
Practice Address - Street 2:STE 265
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2453
Practice Address - Country:US
Practice Address - Phone:501-225-3333
Practice Address - Fax:501-225-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7510208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty