Provider Demographics
NPI:1366841322
Name:KOLLMAN, MELISSA KATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHERINE
Last Name:KOLLMAN
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 1:1790 E MARKET ST STE 64B
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5197
Mailing Address - Country:US
Mailing Address - Phone:540-564-5666
Mailing Address - Fax:757-579-8594
Practice Address - Street 1:1790 E MARKET ST STE 64B
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5197
Practice Address - Country:US
Practice Address - Phone:540-564-5666
Practice Address - Fax:757-579-8594
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50004053363A00000X
VA0110004574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366841322Medicaid