Provider Demographics
NPI:1033199245
Name:WHITMAN, MELANIE (DO)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442
Mailing Address - Country:US
Mailing Address - Phone:843-546-8686
Mailing Address - Fax:843-546-1353
Practice Address - Street 1:57 JESSAMINE AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440
Practice Address - Country:US
Practice Address - Phone:843-546-8686
Practice Address - Fax:843-546-1353
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC938208000000X
SCDO938208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009387Medicaid
SCAA11905677Medicare ID - Type Unspecified
SCI47713Medicare UPIN