Provider Demographics
NPI:1689082273
Name:MELANIE L PETRO, MD, LLC
Entity type:Organization
Organization Name:MELANIE L PETRO, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-568-8012
Mailing Address - Street 1:1995 VES TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1372
Mailing Address - Country:US
Mailing Address - Phone:205-568-8012
Mailing Address - Fax:
Practice Address - Street 1:1995 VES TRACE CIR
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1372
Practice Address - Country:US
Practice Address - Phone:205-568-8012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27512207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty