Provider Demographics
NPI: | 1376635110 |
---|---|
Name: | PITONE, MELANIE L (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MELANIE |
Middle Name: | L |
Last Name: | PITONE |
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 191 |
Mailing Address - Street 2: | PROVIDER ENROLLMENT DEPT |
Mailing Address - City: | ROCKLAND |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19732-0191 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-651-6212 |
Mailing Address - Fax: | 302-651-4945 |
Practice Address - Street 1: | A.I. DUPONT HOSPITAL FOR CHILDREN |
Practice Address - Street 2: | 1600 ROCKLAND ROAD |
Practice Address - City: | WILMINGTON |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19803-3607 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-651-4000 |
Practice Address - Fax: | 302-651-4945 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-29 |
Last Update Date: | 2011-09-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
DE | C10006687 | 207PP0204X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207PP0204X | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 100830042 | Medicaid | |
MD | 1645129 | Medicaid | |
NJ | 9055801 | Medicaid | |
NJ | 9055801 | Medicaid | |
H81846 | Medicare UPIN |