Provider Demographics
NPI:1588954788
Name:WINNINGHAM, MELANIE JEAN (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JEAN
Last Name:WINNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-8962
Practice Address - Street 1:500 MARTHA JEFFERSON DR FL 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4668
Practice Address - Country:US
Practice Address - Phone:434-654-8960
Practice Address - Fax:434-654-8962
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220105722084N0400X
IL0361599082084N0400X
NC2022-001412084N0400X
LA3332722084N0400X
FLME1560742084N0400X
IN01087449A2084N0400X, 2084V0102X
KY562962084N0400X
VA01012629162084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology