Healthcare Provider Details

I. General information

NPI: 1871887349
Provider Name (Legal Business Name): MELISSA S DODRILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 LIBERTY ST
WEST MILFORD WV
26451-6801
US

IV. Provider business mailing address

597 LIBERTY ST
WEST MILFORD WV
26451-6801
US

V. Phone/Fax

Practice location:
  • Phone: 304-745-4568
  • Fax: 304-326-3700
Mailing address:
  • Phone: 304-745-4568
  • Fax: 304-326-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT199754
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25882
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: