Provider Demographics
NPI:1093084782
Name:BARNSWELL, MELLISA TAMIKA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELLISA
Middle Name:TAMIKA
Last Name:BARNSWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9254
Mailing Address - Country:US
Mailing Address - Phone:301-619-7175
Mailing Address - Fax:
Practice Address - Street 1:1434 PORTER ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9254
Practice Address - Country:US
Practice Address - Phone:301-619-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
CAPA22005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider