MEDICARE: JACLYN MELANIE DOVICO M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	2019-01681	NC

General Provider Information

NPI Number	:	1205280864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN MELANIE DOVICO M.D.

Provider Business Mailing Address
First Line	:	5203 BODIE LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-3464
Country	:	US
Telephone Number	:	724-513-5425
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 YANCEYVILLE ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-4932
Country	:	US
Telephone Number	:	336-303-1723
Fax Number	:

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

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	06/11/2026

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