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General NPI Number Information
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NPI Number | 1992070205
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Entity Type | Individual
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Provider Name | MELODY MARIE PHILLIPS MD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 6040 UNIVERSITY TOWN CENTRE DR
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City | MORGANTOWN
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State | WV
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Zip | 26501-2421
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Country | US
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Telephone | 304-598-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 6040 UNIVERSITY TOWN CENTRE DR
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City | MORGANTOWN
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State | WV
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Zip | 26501-2421
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Country | US
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Telephone | 304-598-6900
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125.061226
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26513
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License Number State | WV
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