Healthcare Provider Details

I. General information

NPI: 1619979374
Provider Name (Legal Business Name): MELANIE LYNN GROCH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 6TH ST SUITE 210
OSWEGO NY
13126-2525
US

IV. Provider business mailing address

110 W 6TH ST
OSWEGO NY
13126-2507
US

V. Phone/Fax

Practice location:
  • Phone: 315-349-5828
  • Fax: 315-349-5829
Mailing address:
  • Phone: 315-349-5511
  • Fax: 315-349-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number34-008578
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35008578
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number269960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: