Healthcare Provider Details

I. General information

NPI: 1861483463
Provider Name (Legal Business Name): MELISSA MACCOY ZALE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 E 16TH ST STE B
WILMINGTON DE
19802-5145
US

IV. Provider business mailing address

1802 W 4TH ST
WILMINGTON DE
19805-3420
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-1414
  • Fax: 302-225-4526
Mailing address:
  • Phone: 302-655-5576
  • Fax: 302-655-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME94394
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0008976
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: