Healthcare Provider Details

I. General information

NPI: 1194974451
Provider Name (Legal Business Name): MELISSA PANTALO RAWLINS P.A. - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MIAMISBURG CENTERVILLE RD STE 210
MIAMISBURG OH
45342-7615
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3660
US

V. Phone/Fax

Practice location:
  • Phone: 937-914-7510
  • Fax: 937-914-7508
Mailing address:
  • Phone: 937-914-7044
  • Fax: 937-522-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number002795
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: