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General NPI Number Information
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NPI Number | 1467472225
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Entity Type | Individual
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Provider Name | MELANIE A ROSCOE MD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 11102 SUNRISE BLVD E SUITE 103
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City | PUYALLUP
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State | WA
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Zip | 98374
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Country | US
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Telephone | 253-848-8797
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Fax | 253-446-3239
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Provider Business Mailing Address
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Address Line | 1706 S MERIDIAN SUITE 120
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City | PUYALLUP
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State | WA
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Zip | 98371
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Country | US
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Telephone | 253-848-8797
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Fax | 253-446-3239
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 223213
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD00031239
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License Number State | WA
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