Provider Demographics
NPI:1326662362
Name:MARTINO, MELISSA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 ALPINE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-3559
Mailing Address - Country:US
Mailing Address - Phone:401-419-8517
Mailing Address - Fax:
Practice Address - Street 1:857 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3360
Practice Address - Country:US
Practice Address - Phone:401-467-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant