Healthcare Provider Details

I. General information

NPI: 1356310403
Provider Name (Legal Business Name): MELINDA A SCOTT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7980 N. MAIN ST.
DAYTON OH
45415-2328
US

IV. Provider business mailing address

7980 N. MAIN ST.
DAYTON OH
45415-2328
US

V. Phone/Fax

Practice location:
  • Phone: 937-771-0519
  • Fax: 937-771-0544
Mailing address:
  • Phone: 937-771-0519
  • Fax: 937-771-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34007677
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: