Provider Demographics
NPI:1588484448
Name:MONGOLD, MELANIE G
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:G
Last Name:MONGOLD
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 1:5405 S FORK RD
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-8094
Mailing Address - Country:US
Mailing Address - Phone:304-838-4279
Mailing Address - Fax:
Practice Address - Street 1:5405 S FORK RD
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-8094
Practice Address - Country:US
Practice Address - Phone:304-838-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency