Provider Demographics
NPI:1639465586
Name:RAFFOUL, MELANIE C (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
Last Name:RAFFOUL
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 1:5800 E LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2901
Mailing Address - Country:US
Mailing Address - Phone:972-817-6260
Mailing Address - Fax:
Practice Address - Street 1:1911 OLD FAIRFIELD RD STE 110A
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2754
Practice Address - Country:US
Practice Address - Phone:937-429-4826
Practice Address - Fax:937-429-4575
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121937207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100387Medicaid
OH0100387Medicaid