Provider Demographics
NPI:1871220814
Name:BASKERVILLE, MELINDA
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHINA GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917-3850
Mailing Address - Country:US
Mailing Address - Phone:571-662-1947
Mailing Address - Fax:
Practice Address - Street 1:111 CHINA GROVE RD
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917-3850
Practice Address - Country:US
Practice Address - Phone:571-662-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator