Provider Demographics
NPI:1639403728
Name:METCALFE, MELINDA F (PA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:F
Last Name:METCALFE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:F
Other - Last Name:HOHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 655
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8655
Mailing Address - Country:US
Mailing Address - Phone:585-341-3015
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 655
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8655
Practice Address - Country:US
Practice Address - Phone:585-341-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013559363AM0700X
NY13559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03195737Medicaid
NY03195737Medicaid
NYBA GROUP/J400009428Medicare PIN
NY18007A/J400085409Medicare PIN
NY70008A /J400009427Medicare PIN