Provider Demographics
NPI:1114114758
Name:LAHOOD, MELROSE MAE (NP)
Entity Type:Individual
Prefix:
First Name:MELROSE
Middle Name:MAE
Last Name:LAHOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1221
Mailing Address - Country:US
Mailing Address - Phone:508-892-1969
Mailing Address - Fax:
Practice Address - Street 1:819 WORCESTER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1045
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184642363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4966OtherBLUECROSS BLUESHIELD
MA0703605Medicaid
MANP4966OtherBLUECROSS BLUESHIELD
MAQ39377Medicare UPIN