Provider Demographics
NPI:1144471152
Name:TABOR, MELISSA (DO)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:TABOR
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 1:1000 AUBURN DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:216-593-0661
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:SUITE #410
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-995-2767
Practice Address - Fax:216-593-0661
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012546207QS0010X
FLOS 10487207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine