Provider Demographics
NPI:1124291471
Name:PAVONE, MELANIE DAWN
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:PAVONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 COBBLESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2764
Mailing Address - Country:US
Mailing Address - Phone:304-847-5638
Mailing Address - Fax:
Practice Address - Street 1:315 SOUTH MAIN STREET
Practice Address - Street 2:WEBSTER COUNTY BOARD OF EDUCATION
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288
Practice Address - Country:US
Practice Address - Phone:304-847-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9562083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine