Provider Demographics
NPI:1174896120
Name:MELANIE PALM M.D., P.C.
Entity type:Organization
Organization Name:MELANIE PALM M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-860-7703
Mailing Address - Street 1:437 S HIGHWAY 101
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2228
Mailing Address - Country:US
Mailing Address - Phone:858-792-7546
Mailing Address - Fax:
Practice Address - Street 1:437 S HIGHWAY 101
Practice Address - Street 2:SUITE 217
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2228
Practice Address - Country:US
Practice Address - Phone:858-792-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103899207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty