Healthcare Provider Details

I. General information

NPI: 1598790362
Provider Name (Legal Business Name): STEVEN WYNN MELHORN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SANTA ROSA RD SUITE 103
RICHMOND VA
23229-5109
US

IV. Provider business mailing address

103 N ERLWOOD CT
RICHMOND VA
23229-7679
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-6414
  • Fax: 804-288-9022
Mailing address:
  • Phone: 804-741-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102036926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: