Provider Demographics
NPI:1588008254
Name:MCGLOTHLIN, MELLYNA ANGELICA (DO)
Entity Type:Individual
Prefix:
First Name:MELLYNA
Middle Name:ANGELICA
Last Name:MCGLOTHLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELLYNA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1113 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5591
Mailing Address - Country:US
Mailing Address - Phone:970-225-0040
Mailing Address - Fax:970-225-2996
Practice Address - Street 1:1113 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5591
Practice Address - Country:US
Practice Address - Phone:970-225-0040
Practice Address - Fax:970-225-2996
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine