Provider Demographics
NPI:1740343342
Name:GALE, MELVIN S (MD)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:S
Last Name:GALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 MALSBARY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5521
Mailing Address - Country:US
Mailing Address - Phone:513-241-1811
Mailing Address - Fax:513-241-2112
Practice Address - Street 1:4221 MALSBARY RD STE 102
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5521
Practice Address - Country:US
Practice Address - Phone:513-241-1811
Practice Address - Fax:513-241-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2022-08-09
Deactivation Date:2022-02-22
Deactivation Code:
Reactivation Date:2022-03-28
Provider Licenses
StateLicense IDTaxonomies
OHG338342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0301793Medicaid
OH0426294Medicare ID - Type Unspecified
OH0301793Medicaid