Provider Demographics
NPI:1508307851
Name:ROOT, MELANIE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ROOT
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 1:252 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6111
Mailing Address - Country:US
Mailing Address - Phone:717-270-7688
Mailing Address - Fax:
Practice Address - Street 1:252 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6111
Practice Address - Country:US
Practice Address - Phone:717-270-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-19
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-00741207P00000X
390200000X
PAMD477848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program