Provider Demographics
NPI:1821211251
Name:MONCRIEF, MELISSA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:MONCRIEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:WHITMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:STE. 2100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-395-8556
Mailing Address - Fax:937-522-7873
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:STE. 2100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-395-8556
Practice Address - Fax:937-522-7873
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086867208600000X, 2086S0127X
OH350868672086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2866564Medicaid
OHH540040Medicare PIN
OHWH4242871Medicare PIN