Provider Demographics
NPI:1093917247
Name:NEUWELT, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:NEUWELT
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 1:400 PARNASSUS ST, 7TH FLOOR
Mailing Address - Street 2:BOX 0344
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2534
Mailing Address - Country:US
Mailing Address - Phone:570-628-4444
Mailing Address - Fax:570-628-3088
Practice Address - Street 1:3100 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2498
Practice Address - Country:US
Practice Address - Phone:510-985-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095931207W00000X
PAMD445912207W00000X
CAC150163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102728306Medicaid
PA23-2413259OtherGROUP TAX ID #
PA1861435174OtherGROUP NPI
PA1205878915OtherGROUP NPI
PA20-0300649OtherGROUP TAX ID
PA242839SDHMedicare PIN
PA20-0300649OtherGROUP TAX ID
PA242839YH3HMedicare PIN