Provider Demographics
NPI:1477745024
Name:PETRO, MELANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:PETRO
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 1:905 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2866
Mailing Address - Country:US
Mailing Address - Phone:205-420-8043
Mailing Address - Fax:
Practice Address - Street 1:905 MONTGOMERY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2866
Practice Address - Country:US
Practice Address - Phone:205-420-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27512208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51068099OtherBCBS