Provider Demographics
NPI:1073508982
Name:MCRAE, MELISSA K (DO)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:K
Last Name:MCRAE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:7326 STATE ROUTE 19
Mailing Address - Street 2:UNIT 5014
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9354
Mailing Address - Country:US
Mailing Address - Phone:419-946-1527
Mailing Address - Fax:
Practice Address - Street 1:900 MEADOW DR
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1063
Practice Address - Country:US
Practice Address - Phone:419-946-1085
Practice Address - Fax:419-946-1209
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2010-02-03
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Provider Licenses
StateLicense IDTaxonomies
OH34007177B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274444Medicaid
OHH42590Medicare UPIN