Provider Demographics
NPI:1326364522
Name:MEDVEDEV, MELISSA MORGAN (MD, PHD, MSC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MORGAN
Last Name:MEDVEDEV
Suffix:
Gender:F
Credentials:MD, PHD, MSC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:CAROLYN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 16TH STREET
Mailing Address - Street 2:BOX 1224
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158
Mailing Address - Country:US
Mailing Address - Phone:415-476-6014
Mailing Address - Fax:
Practice Address - Street 1:1975 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2351
Practice Address - Country:US
Practice Address - Phone:415-476-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1200592080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine