Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 128941 | OH |
Y | 2080P0203X | Pediatric Critical Care Doctor | 35.128941 | OH |
N | 2080P0203X | Pediatric Critical Care Doctor | A112334 | CA |
NPI | 1235391954 |
---|---|
Provider Name | Dr. Mellissa E Mahabee |
First Address | Dayton, OH 45404-1815 |
Second Address | Dayton, OH 45404-1815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 18/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0170316 | (05) | OH |