Provider Demographics
NPI:1831322155
Name:MELANIE L PENCE DO LLC
Entity Type:Organization
Organization Name:MELANIE L PENCE DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-343-9600
Mailing Address - Street 1:400 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3207
Mailing Address - Country:US
Mailing Address - Phone:330-343-9600
Mailing Address - Fax:330-343-4410
Practice Address - Street 1:400 MEDICAL PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3207
Practice Address - Country:US
Practice Address - Phone:330-343-9600
Practice Address - Fax:330-343-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty