Healthcare Provider Details

I. General information

NPI: 1952864381
Provider Name (Legal Business Name): MELANIE WORLEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 PEARL PKWY STE 200
BOULDER CO
80301-3080
US

IV. Provider business mailing address

1325 LOCUST AVE
FAIRMONT WV
26554-1435
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-2730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number70248
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number70248
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: