Provider Demographics
NPI:1033113956
Name:HOSTETTER, MELISSA BERG (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BERG
Last Name:HOSTETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9505
Mailing Address - Country:US
Mailing Address - Phone:540-949-0118
Mailing Address - Fax:540-949-8903
Practice Address - Street 1:108 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9505
Practice Address - Country:US
Practice Address - Phone:540-949-0118
Practice Address - Fax:540-949-8903
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
54741OtherOPTIMA
2213464OtherFIRST HEALTH
240285OtherSOUTHERN HEALTH
VA010054290Medicaid
6265006OtherCIGNA
113534OtherANTHEM
VA010054290Medicaid