Provider Demographics
NPI:1114118932
Name:SMITH, MELISSA WELCH (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:WELCH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1150 ROBERT BLVD
Mailing Address - Street 2:STE.360
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2004
Mailing Address - Country:US
Mailing Address - Phone:985-781-4848
Mailing Address - Fax:985-781-4850
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:STE.360
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2004
Practice Address - Country:US
Practice Address - Phone:985-781-4848
Practice Address - Fax:985-781-4850
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA200355207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01857235Medicaid
LAP00638111OtherRAILROAD MEDICARE
LA1028177Medicaid
MS01857235Medicaid
LAP00638111OtherRAILROAD MEDICARE
MS$$$$$$$$$OtherBCBS MS PROVIDER NUMBER