Provider Demographics
NPI:1518986306
Name:KIRICHIAN, MELISSA J (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:KIRICHIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:J
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:292 BERKLEY ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-4924
Mailing Address - Country:US
Mailing Address - Phone:774-218-5419
Mailing Address - Fax:508-880-5247
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 1400-1700
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-880-0077
Practice Address - Fax:508-880-5247
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2005007275-21363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9637OtherBCBS
MAQ70512Medicare UPIN
MANP9637OtherBCBS