Provider Demographics
NPI:1619979374
Name:GROCH, MELANIE LYNN (DO)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:LYNN
Last Name:GROCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2507
Mailing Address - Country:US
Mailing Address - Phone:315-349-5511
Mailing Address - Fax:315-349-5921
Practice Address - Street 1:140 W 6TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2525
Practice Address - Country:US
Practice Address - Phone:315-349-5828
Practice Address - Fax:315-349-5829
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008578207Y00000X
OH35008578207Y00000X
NY269960207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI35512OtherHPM
OHP002360599OtherRRMC
OH7264703OtherAETNA
MI4784400Medicaid
OH000000370241OtherANTHEM
OH25-48240OtherUHC
OH2595900Medicaid
OHPE4167131Medicare PIN
OH2595900Medicaid
MIM35150029Medicare PIN
OHP002360599OtherRRMC
OHPE4167132Medicare PIN