Healthcare Provider Details

I. General information

NPI: 1467484485
Provider Name (Legal Business Name): GAYLE F MELNICK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 STATE ROUTE 159 STE A
CHILLICOTHEE OH
45601-6000
US

IV. Provider business mailing address

4461 STATE ROUTE 159 STE A
CHILLICOTHEE OH
45601-6000
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4900
  • Fax:
Mailing address:
  • Phone: 740-779-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34004014M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: