Provider Demographics
NPI:1295737815
Name:DUFF, MELINDA SUE (PA-C)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:DUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N COUNTY ROAD 25A
Mailing Address - Street 2:SUITE 214
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-332-8777
Mailing Address - Fax:937-332-8773
Practice Address - Street 1:3130 N COUNTY ROAD 25A
Practice Address - Street 2:SUITE 214
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-332-8777
Practice Address - Fax:937-332-8773
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001913363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH240840Medicaid
OH0067779Medicaid
OHP89600Medicare UPIN
OH0067779Medicaid
OH240840Medicaid
PA21071Medicare ID - Type Unspecified