Healthcare Provider Details

I. General information

NPI: 1326068446
Provider Name (Legal Business Name): MELANIE K. CROSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MILLS AVE
ORLANDO FL
32803-5722
US

IV. Provider business mailing address

PO BOX 4918
ORLANDO FL
32802-4918
US

V. Phone/Fax

Practice location:
  • Phone: 407-581-9180
  • Fax: 407-926-9173
Mailing address:
  • Phone: 407-581-9180
  • Fax: 407-926-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME89809
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME89809
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: