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General NPI Number Information
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NPI Number | 1154793503
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Entity Type | Individual
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Provider Name | MEGHAN C. MELINCHAK ATC, LAT, AIB-VR/CON
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Gender | Female
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 121 BLAKE RD
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City | ANNAPOLIS
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State | MD
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Zip | 21402-1300
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Country | US
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Telephone | 724-331-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 121 BLAKE RD
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City | ANNAPOLIS
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State | MD
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Zip | 21402-1300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126001774
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0001242
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License Number State | MD
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