Basic Information
| Provider Information | |||||||||
| NPI: | 1740414283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELZER | ||||||||
| FirstName: | OLGA | ||||||||
| MiddleName: | ALEXANDROVNA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHESTAKOVA | ||||||||
| OtherFirstName: | OLGA | ||||||||
| OtherMiddleName: | ALEXANDROVNA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1123 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008509665 | ||||||||
| FaxNumber: | 2536821714 | ||||||||
| Practice Location | |||||||||
| Address1: | 4777 E GALBRAITH RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136863000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2009 | ||||||||
| LastUpdateDate: | 08/15/2014 | ||||||||
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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 | 207R00000X | 123645 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA09240300 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.