Provider Demographics
NPI:1932179272
Name:CARLSON, MELANIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LYNN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8055 MAYFIELD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:440-214-8027
Mailing Address - Fax:216-201-8173
Practice Address - Street 1:13221 RAVENNA RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9047
Practice Address - Country:US
Practice Address - Phone:440-286-6155
Practice Address - Fax:440-286-6156
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35077011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000201060OtherANTHEM
OH2270279Medicaid
080175491OtherRAILROAD MEDICARE
OHCA4057537Medicare PIN
H44845Medicare UPIN