Provider Demographics
NPI:1821265877
Name:PALM, MELANIE DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DAWN
Last Name:PALM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:437 S. HIGHWAY 101
Mailing Address - Street 2:SUITE# 217
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2221
Mailing Address - Country:US
Mailing Address - Phone:858-792-7546
Mailing Address - Fax:858-792-7007
Practice Address - Street 1:437 S. HIGHWAY 101
Practice Address - Street 2:SUITE# 217
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2221
Practice Address - Country:US
Practice Address - Phone:858-792-7546
Practice Address - Fax:858-792-7007
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA103899207N00000X
IL036120250207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEE230ZMedicare PIN