Provider Demographics
NPI:1427549906
Name:ROBINSON, MELODY A
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2304 OXFORD SHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3215
Mailing Address - Country:US
Mailing Address - Phone:301-535-6975
Mailing Address - Fax:240-213-2551
Practice Address - Street 1:1144 SMALLWOOD DR W # E1
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4759
Practice Address - Country:US
Practice Address - Phone:301-535-6975
Practice Address - Fax:240-213-2551
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222859224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222859OtherLICENSE