Provider Demographics
NPI:1013049261
Name:MELANIE S HADDOX, MD, LLC
Entity type:Organization
Organization Name:MELANIE S HADDOX, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-471-1848
Mailing Address - Street 1:2639 UPTON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3936
Mailing Address - Country:US
Mailing Address - Phone:419-471-1848
Mailing Address - Fax:419-471-0037
Practice Address - Street 1:2639 UPTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3936
Practice Address - Country:US
Practice Address - Phone:419-471-1848
Practice Address - Fax:419-471-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047294T2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0593237Medicaid
000000166089OtherANTHEM
322767OtherMHN HMC
34149182200OtherBWC
DE9270OtherMEDICARE RR
322767OtherMHN HMC
34149182200OtherBWC