Provider Demographics
NPI:1467472225
Name:ROSCOE, MELANIE A (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:ANNE
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1706 S MERIDIAN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371
Mailing Address - Country:US
Mailing Address - Phone:253-848-8797
Mailing Address - Fax:253-446-3239
Practice Address - Street 1:11102 SUNRISE BLVD E
Practice Address - Street 2:SUITE 103
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:253-446-3239
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223213208000000X
WAMD00031239208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics