Basic Information
| Provider Information | |||||||||
| NPI: | 1700084787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DINE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6200 CLEVELAND AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432318608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148980150 | ||||||||
| FaxNumber: | 6148980694 | ||||||||
| Practice Location | |||||||||
| Address1: | 6200 CLEVELAND AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432318608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148980150 | ||||||||
| FaxNumber: | 6148980694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
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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 | 208D00000X | 58001720 | OH | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.