Provider Demographics
NPI:1326240730
Name:PIECH, MELISSA ROETHER (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROETHER
Last Name:PIECH
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 1:131 OLD ROAD TO NINE ACRE CORNER
Mailing Address - Street 2:JOHN CUMING BUILDING, SUITE 770
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-287-8520
Mailing Address - Fax:
Practice Address - Street 1:131 OLD ROAD TO NINE ACRE CORNER
Practice Address - Street 2:JOHN CUMING BUILDING, SUITE 770
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-287-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01212207R00000X
MA250298207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110092397AMedicaid
MA002734201Medicare PIN