Provider Demographics
NPI:1114159993
Name:WONG, MELISSA MEI YIU (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MEI YIU
Last Name:WONG
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 1:764 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5210
Mailing Address - Country:US
Mailing Address - Phone:603-669-3925
Mailing Address - Fax:
Practice Address - Street 1:764 2ND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5210
Practice Address - Country:US
Practice Address - Phone:603-669-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0194207W00000X
MA240927207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47901811Medicaid
NM365735YTQZOtherMEDICARE PTAN