Provider Demographics
NPI:1700864196
Name:PAYNE, MELINDA L (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:PAYNE
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 1:301 PROSPECT AVE
Mailing Address - Street 2:3-6 INPATIENT MENTAL HEALTH
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5360
Mailing Address - Fax:315-448-6137
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:3-6 INPATIENT MENTAL HEALTH
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5360
Practice Address - Fax:315-448-6137
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1566632084P0800X
MT64902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0048308Medicaid