Provider Demographics
NPI:1558543421
Name:SMITH, MELISSA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 SUPERIOR AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3600
Mailing Address - Country:US
Mailing Address - Phone:949-642-7600
Mailing Address - Fax:949-642-7606
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-642-7600
Practice Address - Fax:949-642-7606
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84857208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN079XMedicare PIN
CAAN079YMedicare PIN
CAAN079AMedicare PIN
CAAN079ZMedicare PIN