Provider Demographics
NPI:1467675181
Name:MORTENSEN-WELCH, MELISSA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:MORTENSEN-WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF SURGERY OTOLARYNGOLOGY
Mailing Address - Street 2:STONY BROOK UNIV MEDICAL CENTER, HSCT19-064
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8191
Mailing Address - Country:US
Mailing Address - Phone:631-444-8410
Mailing Address - Fax:631-444-7635
Practice Address - Street 1:37 RESEARCH WAY
Practice Address - Street 2:STONY BROOK SURGICAL ASSOCIATES
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-9200
Practice Address - Country:US
Practice Address - Phone:631-444-4121
Practice Address - Fax:631-444-4189
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2341737207YS0012X
VA0101243259207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400050506Medicare PIN