Provider Demographics
NPI:1588632731
Name:NAGLE, MELINDA L (MD)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:L
Last Name:NAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1450 E VALLEY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8352
Mailing Address - Country:US
Mailing Address - Phone:970-927-1717
Mailing Address - Fax:970-927-6164
Practice Address - Street 1:1450 E VALLEY RD
Practice Address - Street 2:STE 105 ALL VALLEY WOMENS CARE
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8352
Practice Address - Country:US
Practice Address - Phone:970-927-1717
Practice Address - Fax:970-927-6164
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39222207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609842145OtherGROUP NPI
201467647OtherTAX ID
CO24072052Medicaid
H32914Medicare UPIN
COC554778Medicare PIN