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General NPI Number Information
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NPI Number | 1194703009
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Entity Type | Individual
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Provider Name | MELODY ANN GONGWER M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 1315 HILLCREST RD
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City | BEDFORD
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State | IN
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Zip | 47421-3023
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Country | US
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Telephone | 812-279-3591
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Fax | 812-275-0787
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Provider Business Mailing Address
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Address Line | 645 S ROGERS ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2353
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Country | US
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Telephone | 812-339-1691
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Fax | 812-337-2259
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01051287A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 01051287A
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License Number State | IN
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