Provider Demographics
NPI:1972940195
Name:TRIPOLI, MELISSA (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TRIPOLI
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 1:1717 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3676
Mailing Address - Country:US
Mailing Address - Phone:740-522-8555
Mailing Address - Fax:740-522-3620
Practice Address - Street 1:1717 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1385
Practice Address - Country:US
Practice Address - Phone:740-522-8555
Practice Address - Fax:740-522-3620
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT203969390200000X
PA1972940195207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program