Provider Demographics
NPI:1700084787
Name:DINE, MELISSA A (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:DINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 CLEVELAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8608
Mailing Address - Country:US
Mailing Address - Phone:614-898-0150
Mailing Address - Fax:614-898-0694
Practice Address - Street 1:6200 CLEVELAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-8608
Practice Address - Country:US
Practice Address - Phone:614-898-0150
Practice Address - Fax:614-898-0694
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58001720208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice