Provider Demographics
NPI:1730110636
Name:MELISSA K MCRAE, D.O., INC
Entity Type:Organization
Organization Name:MELISSA K MCRAE, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-946-1085
Mailing Address - Street 1:900 MEADOW DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338
Mailing Address - Country:US
Mailing Address - Phone:419-946-1085
Mailing Address - Fax:419-946-1209
Practice Address - Street 1:900 MEADOW DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338
Practice Address - Country:US
Practice Address - Phone:419-946-1085
Practice Address - Fax:419-946-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9363271Medicare PIN