Provider Demographics
NPI:1184715948
Name:GAMPONIA, MELISSA JOSE (MD MPH)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOSE
Last Name:GAMPONIA
Suffix:
Gender:F
Credentials:MD MPH
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Mailing Address - Street 1:208 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1160
Mailing Address - Country:US
Mailing Address - Phone:304-343-4300
Mailing Address - Fax:304-343-5473
Practice Address - Street 1:208 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-1160
Practice Address - Country:US
Practice Address - Phone:304-343-4300
Practice Address - Fax:304-343-5473
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV17020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000372286OtherMS BCBS
WV0125358000Medicaid
F74104Medicare UPIN
WV000372286OtherMS BCBS