Provider Demographics
NPI:1821094913
Name:KNOX, MELISSA JANE (DPM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:KNOX
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KNOX
Other - Last Name:DUMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:127 S CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1619
Mailing Address - Country:US
Mailing Address - Phone:814-472-4919
Mailing Address - Fax:814-472-4961
Practice Address - Street 1:127 S CAROLINE ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1619
Practice Address - Country:US
Practice Address - Phone:814-472-4919
Practice Address - Fax:814-472-4961
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004163R213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01552896Medicaid
PA805821LZCMedicare ID - Type Unspecified
PA01552896Medicaid