Basic Information
| Provider Information | |||||||||
| NPI: | 1467472225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSCOE | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STILLMAN | ||||||||
| OtherFirstName: | MELANIE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1706 S MERIDIAN | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538488797 | ||||||||
| FaxNumber: | 2534463239 | ||||||||
| Practice Location | |||||||||
| Address1: | 11102 SUNRISE BLVD E | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538488797 | ||||||||
| FaxNumber: | 2534463239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 09/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 223213 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD00031239 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.