MEDICARE: MS. MELISSA K MCRAE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34007177B	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073508982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA K MCRAE D.O.

Provider Business Mailing Address
First Line	:	7326 STATE ROUTE 19
Second Line	:	UNIT 5014
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-9354
Country	:	US
Telephone Number	:	419-946-1527
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 MEADOW DR
Second Line	:	SUITE C
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1063
Country	:	US
Telephone Number	:	419-946-1085
Fax Number	:	419-946-1209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	02/03/2010

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