Provider Demographics
NPI:1699755058
Name:HANCOCK, MELISSA SUBLETT (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUBLETT
Last Name:HANCOCK
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0610
Mailing Address - Fax:502-588-0611
Practice Address - Street 1:9702 STONESTREET ROAD
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-6809
Practice Address - Country:US
Practice Address - Phone:502-588-0610
Practice Address - Fax:502-588-0611
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200111450Medicaid
KY64304975Medicaid
G49327Medicare UPIN
KYP400039883Medicare PIN
IN200111450Medicaid