Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 34-008578 | OH |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35008578 | OH |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 269960 | NY |
NPI | 1619979374 |
---|---|
Provider Name | Ms. Melanie Lynn Groch |
First Address | Oswego, NY 13126-2525 |
Second Address | Oswego, NY 13126-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 30/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000370241 | ANTHEM (01) | OH |
25-48240 | UHC (01) | OH |
2595900 | (05) | OH |
35512 | HPM (01) | MI |
4784400 | (05) | MI |
7264703 | AETNA (01) | OH |
P002360599 | RRMC (01) | OH |