Provider Demographics
NPI:1841213980
Name:EMMERT, MELANIE H (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:H
Last Name:EMMERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5222
Mailing Address - Country:US
Mailing Address - Phone:407-767-2477
Mailing Address - Fax:407-834-9822
Practice Address - Street 1:846 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5222
Practice Address - Country:US
Practice Address - Phone:407-767-2477
Practice Address - Fax:407-834-9822
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64120959Medicaid
KY64120959Medicaid
KY693112Medicare PIN