Provider Demographics
NPI:1063902294
Name:VOGT, MELISSA (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8170 ROURK ST STE 150
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4127
Mailing Address - Country:US
Mailing Address - Phone:854-854-7170
Mailing Address - Fax:854-854-7171
Practice Address - Street 1:8170 ROURK ST STE 150
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4127
Practice Address - Country:US
Practice Address - Phone:854-854-7170
Practice Address - Fax:854-854-7171
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA102301207V00000X
SC87763207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology