Provider Demographics
NPI:1598939464
Name:WALTER, MELANIE REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:REBECCA
Last Name:WALTER
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:PO BOX 8734
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0725
Mailing Address - Country:US
Mailing Address - Phone:540-395-3376
Mailing Address - Fax:540-427-7858
Practice Address - Street 1:2000 STEPHENSON AVE.
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-0000
Practice Address - Country:US
Practice Address - Phone:540-395-3376
Practice Address - Fax:540-427-7858
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00630207N00000X
VA0101252185207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology