Provider Demographics
NPI:1689699712
Name:PRUSAKOWSKI, MELANIE K (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
Last Name:PRUSAKOWSKI
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 RIVERSIDE CIR
Mailing Address - Street 2:4TH FLOOR, ED ADMINISTRATION
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4961
Mailing Address - Country:US
Mailing Address - Phone:540-597-4234
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:CARILION ROANOKE MEMORIAL HOSPITAL PEDS ED
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-981-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01012431162080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics