Provider Demographics
NPI:1316025372
Name:ANTONIK, MELISSA JOHNSON (MD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOHNSON
Last Name:ANTONIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3020 HAMAKER CT STE 502
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2220
Mailing Address - Country:US
Mailing Address - Phone:703-849-8440
Mailing Address - Fax:703-849-0032
Practice Address - Street 1:3020 HAMAKER CT STE 502
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2220
Practice Address - Country:US
Practice Address - Phone:703-849-8440
Practice Address - Fax:703-849-0032
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245254207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism