Provider Demographics
NPI:1376510172
Name:LONGOBARDI, MELISSA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:LONGOBARDI
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 1:106 COMMON FENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-5610
Mailing Address - Country:US
Mailing Address - Phone:401-728-7556
Mailing Address - Fax:
Practice Address - Street 1:571 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2837
Practice Address - Country:US
Practice Address - Phone:401-864-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7009808Medicaid
RIP48698Medicare UPIN
RI007009808Medicare ID - Type UnspecifiedMEDICARE