Provider Demographics
NPI:1902847742
Name:PAYNE, MELISSA A (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:PAYNE
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 1:550 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1421
Mailing Address - Country:US
Mailing Address - Phone:740-363-1904
Mailing Address - Fax:
Practice Address - Street 1:550 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1421
Practice Address - Country:US
Practice Address - Phone:740-363-1904
Practice Address - Fax:740-363-5288
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-5839-P207Q00000X
OH35.075839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2185611Medicaid