Provider Demographics
NPI:1346221371
Name:HOPKINS, MELISSA J (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2914
Mailing Address - Country:US
Mailing Address - Phone:345-678-1502
Mailing Address - Fax:234-567-8189
Practice Address - Street 1:564 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2914
Practice Address - Country:US
Practice Address - Phone:345-678-1502
Practice Address - Fax:234-567-8189
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001219363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074838Medicaid
OHHOPA13386Medicare PIN
OHHOPA13387Medicare PIN
OHHOPA13383Medicare PIN