Provider Demographics
NPI:1225109051
Name:MELCHREIT, ANNA-MARIE L (MD)
Entity Type:Individual
Prefix:
First Name:ANNA-MARIE
Middle Name:L
Last Name:MELCHREIT
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 1:495 GOLD STAR HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6228
Mailing Address - Country:US
Mailing Address - Phone:860-449-8882
Mailing Address - Fax:869-449-9195
Practice Address - Street 1:495 GOLD STAR HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6228
Practice Address - Country:US
Practice Address - Phone:860-449-8882
Practice Address - Fax:869-449-9195
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030633208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2935675-002OtherCIGNA
5769094OtherAETNA
NLP062OtherOXFORD
010030633CT01OtherBLUE CROSS BLUE SHIELD
030091OtherHEALTH NET
759963OtherCONNECTICARE
CT001306332Medicaid
370000708Medicare UPIN